| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
457 |
296 |
$78K |
| D1120 |
Prophylaxis - child |
785 |
760 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,110 |
1,077 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
872 |
846 |
$44K |
| D0272 |
Bitewings - two radiographic images |
679 |
662 |
$30K |
| D1110 |
Prophylaxis - adult |
320 |
311 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
172 |
112 |
$28K |
| D1351 |
Sealant - per tooth |
515 |
191 |
$27K |
| D0274 |
Bitewings - four radiographic images |
393 |
389 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
68 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
253 |
$23K |
| D2140 |
|
120 |
83 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
271 |
184 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
140 |
123 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
320 |
318 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
12 |
$4K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$3K |