| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
706 |
544 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,169 |
903 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
883 |
694 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,078 |
839 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
158 |
65 |
$12K |
| D1120 |
Prophylaxis - child |
349 |
263 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
465 |
366 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
33 |
33 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
102 |
92 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
18 |
$981.80 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$372.40 |