| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
882 |
508 |
$67K |
| D1110 |
Prophylaxis - adult |
1,329 |
1,280 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,737 |
1,661 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,098 |
1,069 |
$34K |
| D2160 |
|
313 |
207 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,440 |
1,355 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
770 |
715 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,066 |
1,024 |
$18K |
| D0272 |
Bitewings - two radiographic images |
792 |
722 |
$18K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
15 |
$10K |
| D1206 |
Topical application of fluoride varnish |
264 |
254 |
$5K |
| D1120 |
Prophylaxis - child |
123 |
95 |
$4K |
| D2140 |
|
67 |
44 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
24 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
30 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
13 |
$410.40 |
| D0274 |
Bitewings - four radiographic images |
28 |
26 |
$350.50 |