| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
246 |
149 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
650 |
650 |
$13K |
| D1110 |
Prophylaxis - adult |
266 |
266 |
$11K |
| D1120 |
Prophylaxis - child |
397 |
397 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
677 |
677 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
307 |
298 |
$8K |
| D0272 |
Bitewings - two radiographic images |
248 |
248 |
$4K |
| D2140 |
|
71 |
49 |
$4K |
| D0330 |
Panoramic radiographic image |
78 |
78 |
$4K |
| D2160 |
|
23 |
15 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
111 |
111 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
31 |
31 |
$888.65 |