| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,198 |
1,065 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,521 |
1,357 |
$38K |
| D0240 |
|
1,252 |
563 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,492 |
1,331 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
321 |
151 |
$25K |
| D0272 |
Bitewings - two radiographic images |
995 |
891 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
103 |
14 |
$14K |
| D1110 |
Prophylaxis - adult |
292 |
260 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
435 |
359 |
$10K |
| D0603 |
|
1,171 |
1,072 |
$6K |
| D9248 |
|
46 |
29 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
50 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$188.55 |