| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,341 |
1,396 |
$242K |
| D0120 |
Periodic oral evaluation - established patient |
5,245 |
5,190 |
$150K |
| D1110 |
Prophylaxis - adult |
2,803 |
2,756 |
$140K |
| D2140 |
|
1,804 |
1,186 |
$133K |
| D1120 |
Prophylaxis - child |
3,450 |
3,411 |
$124K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,132 |
2,439 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,782 |
4,731 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,774 |
3,266 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,482 |
2,447 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,429 |
3,368 |
$50K |
| D0330 |
Panoramic radiographic image |
379 |
378 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
477 |
466 |
$23K |
| D2160 |
|
29 |
25 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
38 |
$3K |