| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,395 |
2,962 |
$448K |
| D1110 |
Prophylaxis - adult |
6,936 |
6,839 |
$381K |
| D0120 |
Periodic oral evaluation - established patient |
9,073 |
8,970 |
$312K |
| D1206 |
Topical application of fluoride varnish |
9,764 |
9,616 |
$272K |
| D0274 |
Bitewings - four radiographic images |
6,529 |
6,433 |
$265K |
| D0330 |
Panoramic radiographic image |
2,339 |
2,302 |
$185K |
| D1120 |
Prophylaxis - child |
4,128 |
4,068 |
$154K |
| D2331 |
|
1,427 |
978 |
$137K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,070 |
600 |
$101K |
| D2140 |
|
1,654 |
1,160 |
$93K |
| D0272 |
Bitewings - two radiographic images |
2,834 |
2,787 |
$93K |
| D2160 |
|
1,075 |
804 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,996 |
1,933 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
1,825 |
1,761 |
$67K |
| D1351 |
Sealant - per tooth |
1,603 |
427 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,485 |
2,115 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
621 |
405 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,323 |
2,241 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
475 |
323 |
$27K |
| D2332 |
|
210 |
143 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
77 |
42 |
$15K |
| D2330 |
|
111 |
68 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
25 |
$475.73 |
| D2335 |
|
152 |
94 |
$0.00 |
| D2161 |
|
14 |
12 |
$0.00 |