| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,143 |
2,773 |
$381K |
| D1110 |
Prophylaxis - adult |
7,937 |
7,332 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
13,755 |
12,623 |
$352K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,458 |
12,365 |
$257K |
| D0272 |
Bitewings - two radiographic images |
11,486 |
10,610 |
$251K |
| D1120 |
Prophylaxis - child |
5,669 |
5,151 |
$196K |
| D2140 |
|
2,864 |
1,924 |
$175K |
| D0210 |
Intraoral - complete series of radiographic images |
1,731 |
1,531 |
$133K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,935 |
2,549 |
$71K |
| D1351 |
Sealant - per tooth |
2,486 |
825 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
3,466 |
2,862 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
464 |
307 |
$31K |
| D2160 |
|
258 |
153 |
$22K |
| D0603 |
|
1,846 |
1,704 |
$9K |
| D0602 |
|
866 |
795 |
$4K |
| D0330 |
Panoramic radiographic image |
159 |
159 |
$1K |
| D0601 |
|
271 |
245 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
39 |
$623.98 |