| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,807 |
3,807 |
$118K |
| D1206 |
Topical application of fluoride varnish |
6,391 |
6,390 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
4,840 |
4,839 |
$110K |
| D1110 |
Prophylaxis - adult |
2,503 |
2,502 |
$106K |
| D0330 |
Panoramic radiographic image |
816 |
816 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,198 |
1,159 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
856 |
856 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,019 |
1,019 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,419 |
1,419 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
206 |
128 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
54 |
26 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
24 |
$4K |
| D2140 |
|
47 |
30 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
52 |
52 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
49 |
49 |
$614.46 |