| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
132 |
70 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
304 |
292 |
$8K |
| D1110 |
Prophylaxis - adult |
161 |
158 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
21 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
264 |
$5K |
| D1120 |
Prophylaxis - child |
133 |
124 |
$5K |
| D0272 |
Bitewings - two radiographic images |
182 |
174 |
$4K |
| D1206 |
Topical application of fluoride varnish |
191 |
183 |
$4K |
| D2140 |
|
49 |
26 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
242 |
210 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
51 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
69 |
65 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
20 |
$558.60 |
| D0602 |
|
37 |
37 |
$175.00 |