| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
732 |
438 |
$53K |
| D2140 |
|
206 |
154 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
300 |
272 |
$8K |
| D1120 |
Prophylaxis - child |
210 |
210 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
249 |
247 |
$6K |
| D1206 |
Topical application of fluoride varnish |
293 |
290 |
$6K |
| D2160 |
|
69 |
42 |
$6K |
| D0272 |
Bitewings - two radiographic images |
125 |
125 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
16 |
14 |
$492.25 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$468.00 |
| D1999 |
|
24 |
16 |
$0.00 |