| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,739 |
904 |
$126K |
| D1110 |
Prophylaxis - adult |
2,702 |
2,415 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
4,251 |
3,760 |
$105K |
| D0272 |
Bitewings - two radiographic images |
3,246 |
2,886 |
$74K |
| D2140 |
|
970 |
550 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,057 |
2,670 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,011 |
339 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
2,563 |
2,244 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,648 |
1,363 |
$41K |
| D1120 |
Prophylaxis - child |
1,172 |
1,028 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
474 |
410 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
955 |
832 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,838 |
1,600 |
$25K |
| D1206 |
Topical application of fluoride varnish |
594 |
580 |
$11K |
| D0330 |
Panoramic radiographic image |
38 |
27 |
$2K |
| D1999 |
|
33 |
28 |
$0.00 |