| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
931 |
492 |
$90K |
| D1120 |
Prophylaxis - child |
2,001 |
1,975 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,416 |
2,382 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,705 |
2,670 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,046 |
1,042 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
484 |
204 |
$30K |
| D1110 |
Prophylaxis - adult |
560 |
550 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
872 |
739 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
244 |
244 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
437 |
426 |
$6K |
| D2140 |
|
105 |
74 |
$6K |
| D0272 |
Bitewings - two radiographic images |
239 |
239 |
$4K |
| D2160 |
|
17 |
14 |
$2K |