| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
683 |
671 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
291 |
288 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
128 |
55 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
209 |
205 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
298 |
295 |
$3K |
| D0272 |
Bitewings - two radiographic images |
236 |
233 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
258 |
244 |
$2K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
279 |
226 |
$2K |
| D1206 |
Topical application of fluoride varnish |
393 |
386 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
48 |
39 |
$1K |
| D2140 |
|
18 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
38 |
$811.36 |