| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,352 |
1,309 |
$66K |
| D1120 |
Prophylaxis - child |
841 |
803 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
361 |
257 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,079 |
1,040 |
$53K |
| D0330 |
Panoramic radiographic image |
527 |
510 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,172 |
1,121 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
504 |
480 |
$47K |
| D1110 |
Prophylaxis - adult |
394 |
381 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
364 |
156 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
441 |
423 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
730 |
704 |
$22K |
| D2140 |
|
159 |
119 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
478 |
322 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
36 |
$11K |
| D1351 |
Sealant - per tooth |
69 |
28 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$1K |