| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
506 |
294 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,292 |
1,058 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
853 |
840 |
$22K |
| D1120 |
Prophylaxis - child |
522 |
519 |
$17K |
| D1110 |
Prophylaxis - adult |
362 |
359 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
763 |
759 |
$15K |
| D0272 |
Bitewings - two radiographic images |
678 |
677 |
$14K |
| D0330 |
Panoramic radiographic image |
84 |
82 |
$4K |
| D2140 |
|
58 |
36 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
43 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
29 |
$440.01 |