| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
252 |
96 |
$20K |
| D1110 |
Prophylaxis - adult |
261 |
181 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
440 |
301 |
$11K |
| D2140 |
|
137 |
39 |
$9K |
| D0272 |
Bitewings - two radiographic images |
373 |
254 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
225 |
145 |
$6K |
| D2160 |
|
45 |
24 |
$4K |
| D1206 |
Topical application of fluoride varnish |
196 |
137 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
16 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
169 |
100 |
$3K |
| D1120 |
Prophylaxis - child |
54 |
37 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
66 |
42 |
$1K |
| D0601 |
|
128 |
88 |
$615.00 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
12 |
$527.20 |
| D0602 |
|
97 |
64 |
$411.02 |
| D0603 |
|
15 |
12 |
$70.00 |