| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
491 |
486 |
$23K |
| D0240 |
|
668 |
343 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
619 |
614 |
$16K |
| D0272 |
Bitewings - two radiographic images |
441 |
439 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
502 |
500 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
111 |
109 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
61 |
32 |
$5K |
| D1120 |
Prophylaxis - child |
92 |
92 |
$3K |
| D2160 |
|
32 |
16 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
50 |
43 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$198.55 |