| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,045 |
731 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,440 |
2,236 |
$79K |
| D1120 |
Prophylaxis - child |
1,830 |
1,830 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,053 |
2,053 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
380 |
333 |
$42K |
| D1110 |
Prophylaxis - adult |
833 |
833 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
388 |
282 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,377 |
2,377 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,070 |
2,070 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
572 |
572 |
$23K |
| D0274 |
Bitewings - four radiographic images |
685 |
685 |
$19K |
| D2140 |
|
311 |
247 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
906 |
906 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
374 |
371 |
$15K |
| D0330 |
Panoramic radiographic image |
362 |
362 |
$14K |
| D2160 |
|
113 |
80 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
82 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
721 |
707 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
56 |
$9K |