| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,758 |
863 |
$105K |
| D1110 |
Prophylaxis - adult |
1,891 |
1,874 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,833 |
2,819 |
$86K |
| D1206 |
Topical application of fluoride varnish |
3,403 |
3,374 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,118 |
2,106 |
$73K |
| D1351 |
Sealant - per tooth |
2,723 |
600 |
$62K |
| D1120 |
Prophylaxis - child |
1,769 |
1,759 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
2,252 |
1,889 |
$52K |
| D2140 |
|
1,096 |
560 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,039 |
1,034 |
$26K |
| D0330 |
Panoramic radiographic image |
416 |
409 |
$16K |
| D2160 |
|
323 |
183 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,125 |
1,029 |
$12K |
| D1330 |
|
199 |
199 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
428 |
278 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
12 |
$3K |
| D2330 |
|
165 |
79 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
27 |
$309.03 |
| D4355 |
|
12 |
12 |
$0.00 |