| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,260 |
780 |
$90K |
| D1120 |
Prophylaxis - child |
2,145 |
2,103 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,948 |
2,892 |
$69K |
| D1206 |
Topical application of fluoride varnish |
3,158 |
3,106 |
$63K |
| D1110 |
Prophylaxis - adult |
1,495 |
1,466 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
822 |
817 |
$46K |
| D2140 |
|
554 |
397 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
774 |
758 |
$21K |
| D0274 |
Bitewings - four radiographic images |
728 |
721 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,085 |
1,067 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
40 |
26 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
670 |
623 |
$19K |
| D2160 |
|
226 |
174 |
$18K |
| D1351 |
Sealant - per tooth |
463 |
135 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
467 |
444 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
16 |
$1K |
| D0330 |
Panoramic radiographic image |
31 |
29 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
42 |
$844.60 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$289.92 |
| D1999 |
|
98 |
78 |
$0.00 |