| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
784 |
776 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
278 |
167 |
$18K |
| D0350 |
|
2,616 |
757 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
405 |
344 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,820 |
748 |
$12K |
| D1351 |
Sealant - per tooth |
517 |
174 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
451 |
447 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
757 |
749 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
223 |
222 |
$8K |
| D2140 |
|
128 |
82 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
102 |
57 |
$5K |
| D0272 |
Bitewings - two radiographic images |
469 |
465 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
34 |
$3K |
| D0274 |
Bitewings - four radiographic images |
75 |
75 |
$1K |
| D9430 |
|
14 |
14 |
$308.00 |