| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,560 |
1,012 |
$189K |
| D1120 |
Prophylaxis - child |
3,659 |
3,563 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,346 |
5,188 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,260 |
4,143 |
$100K |
| D0330 |
Panoramic radiographic image |
1,877 |
1,828 |
$87K |
| D1110 |
Prophylaxis - adult |
1,986 |
1,917 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,352 |
2,276 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,907 |
1,689 |
$55K |
| D1351 |
Sealant - per tooth |
1,322 |
443 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,354 |
1,325 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,495 |
2,229 |
$28K |
| D1353 |
|
611 |
166 |
$17K |
| D2140 |
|
198 |
98 |
$12K |
| D0272 |
Bitewings - two radiographic images |
467 |
455 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
771 |
523 |
$4K |
| D4346 |
|
81 |
81 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
83 |
$2K |
| D1206 |
Topical application of fluoride varnish |
71 |
71 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
14 |
$1K |
| D1999 |
|
35 |
35 |
$0.00 |
| D1330 |
|
19 |
19 |
$0.00 |