| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,586 |
1,008 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
4,888 |
4,871 |
$137K |
| D1110 |
Prophylaxis - adult |
2,698 |
2,685 |
$134K |
| D1120 |
Prophylaxis - child |
3,698 |
3,670 |
$133K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,219 |
2,807 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,920 |
4,908 |
$101K |
| D2140 |
|
966 |
754 |
$71K |
| D0272 |
Bitewings - two radiographic images |
2,677 |
2,667 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,078 |
992 |
$48K |
| D2160 |
|
177 |
117 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
795 |
772 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
456 |
442 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
77 |
77 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$1K |