| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,725 |
1,030 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,578 |
4,180 |
$118K |
| D1110 |
Prophylaxis - adult |
2,400 |
2,199 |
$110K |
| D0272 |
Bitewings - two radiographic images |
3,828 |
3,533 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,438 |
3,134 |
$67K |
| D1120 |
Prophylaxis - child |
1,897 |
1,725 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,268 |
1,825 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
706 |
369 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
694 |
622 |
$11K |
| D2140 |
|
115 |
83 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
77 |
65 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
12 |
$2K |
| D0602 |
|
126 |
120 |
$585.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$376.20 |
| D0601 |
|
32 |
26 |
$155.00 |
| D0603 |
|
18 |
18 |
$85.00 |