| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,580 |
1,492 |
$179K |
| D1110 |
Prophylaxis - adult |
3,056 |
2,995 |
$124K |
| D1120 |
Prophylaxis - child |
3,720 |
3,640 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
5,043 |
4,951 |
$112K |
| D1206 |
Topical application of fluoride varnish |
3,756 |
3,675 |
$69K |
| D2140 |
|
1,130 |
787 |
$65K |
| D0330 |
Panoramic radiographic image |
1,748 |
1,695 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,803 |
2,744 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,002 |
1,959 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,201 |
1,171 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,000 |
827 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,498 |
1,455 |
$24K |
| D2160 |
|
251 |
175 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
723 |
696 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
64 |
$1K |
| D0431 |
|
6,574 |
6,450 |
$735.00 |