| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,554 |
1,082 |
$170K |
| D1110 |
Prophylaxis - adult |
3,164 |
2,927 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,202 |
792 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
4,512 |
4,197 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,079 |
465 |
$86K |
| D1120 |
Prophylaxis - child |
2,176 |
2,044 |
$60K |
| D2140 |
|
1,131 |
525 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,020 |
2,802 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,225 |
1,127 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
672 |
620 |
$27K |
| D0330 |
Panoramic radiographic image |
740 |
685 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
625 |
567 |
$21K |
| D0272 |
Bitewings - two radiographic images |
904 |
845 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
281 |
244 |
$7K |
| D1351 |
Sealant - per tooth |
93 |
29 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$2K |
| D2160 |
|
21 |
16 |
$2K |
| D0240 |
|
100 |
29 |
$740.00 |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
30 |
$315.38 |