| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
705 |
434 |
$61K |
| D1120 |
Prophylaxis - child |
1,087 |
1,087 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,392 |
1,392 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,021 |
834 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,598 |
1,598 |
$23K |
| D1110 |
Prophylaxis - adult |
516 |
516 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
237 |
129 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
298 |
297 |
$8K |
| D0274 |
Bitewings - four radiographic images |
261 |
261 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
463 |
462 |
$7K |
| D0272 |
Bitewings - two radiographic images |
374 |
374 |
$6K |
| D2140 |
|
80 |
62 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
157 |
157 |
$4K |
| D2160 |
|
31 |
25 |
$3K |