| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,451 |
690 |
$64K |
| D1110 |
Prophylaxis - adult |
1,485 |
1,436 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
706 |
329 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,595 |
1,570 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,011 |
938 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,980 |
1,923 |
$24K |
| D0330 |
Panoramic radiographic image |
849 |
797 |
$20K |
| D2160 |
|
397 |
257 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
537 |
262 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
275 |
151 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
965 |
887 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,561 |
1,489 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,086 |
1,933 |
$13K |
| D2140 |
|
286 |
158 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
100 |
$8K |
| D1120 |
Prophylaxis - child |
429 |
418 |
$8K |
| D4210 |
|
80 |
27 |
$7K |
| D1351 |
Sealant - per tooth |
403 |
107 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,334 |
1,375 |
$4K |
| D4341 |
|
153 |
42 |
$4K |
| D2331 |
|
73 |
46 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
82 |
62 |
$1K |
| D9420 |
|
48 |
47 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
42 |
$1K |
| D9110 |
|
44 |
37 |
$1K |
| D0272 |
Bitewings - two radiographic images |
64 |
63 |
$432.32 |
| D0240 |
|
62 |
27 |
$213.84 |
| D0270 |
|
48 |
46 |
$161.76 |