| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
538 |
264 |
$41K |
| D1110 |
Prophylaxis - adult |
909 |
694 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,388 |
1,042 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,065 |
824 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,083 |
833 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
644 |
445 |
$16K |
| D2140 |
|
253 |
145 |
$15K |
| D1120 |
Prophylaxis - child |
351 |
249 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
36 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
70 |
40 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$125.40 |