| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
990 |
844 |
$22K |
| D1110 |
Prophylaxis - adult |
424 |
371 |
$17K |
| D0272 |
Bitewings - two radiographic images |
805 |
683 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
194 |
78 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
609 |
509 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
285 |
214 |
$4K |
| D1120 |
Prophylaxis - child |
106 |
82 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
114 |
92 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
14 |
$2K |