| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
640 |
615 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
219 |
73 |
$16K |
| D1110 |
Prophylaxis - adult |
263 |
254 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
473 |
385 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
607 |
583 |
$12K |
| D0272 |
Bitewings - two radiographic images |
403 |
395 |
$10K |
| D1120 |
Prophylaxis - child |
273 |
258 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
529 |
509 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
92 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
86 |
50 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
480 |
455 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
46 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23 |
12 |
$3K |
| D0603 |
|
410 |
390 |
$2K |
| D2140 |
|
21 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
34 |
$1K |
| D1206 |
Topical application of fluoride varnish |
24 |
23 |
$478.80 |
| D0602 |
|
45 |
45 |
$211.77 |