| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,977 |
1,919 |
$74K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
679 |
440 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,463 |
2,379 |
$72K |
| D1110 |
Prophylaxis - adult |
1,303 |
1,250 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,620 |
1,471 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,653 |
2,571 |
$57K |
| D0272 |
Bitewings - two radiographic images |
1,329 |
1,290 |
$31K |
| D2140 |
|
307 |
257 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
394 |
383 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
296 |
287 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
247 |
243 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$620.41 |