| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2160 |
|
1,738 |
1,126 |
$166K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,074 |
1,337 |
$163K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,178 |
1,169 |
$160K |
| D1351 |
Sealant - per tooth |
5,527 |
1,323 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
4,751 |
4,665 |
$130K |
| D1120 |
Prophylaxis - child |
3,601 |
3,537 |
$126K |
| D1110 |
Prophylaxis - adult |
2,125 |
2,099 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,437 |
4,556 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,769 |
5,677 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,348 |
2,309 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,081 |
1,057 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,030 |
4,909 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,917 |
1,732 |
$50K |
| D0272 |
Bitewings - two radiographic images |
1,750 |
1,724 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
37 |
$6K |
| D2140 |
|
20 |
13 |
$1K |
| D0603 |
|
6,335 |
6,261 |
$0.00 |
| D0602 |
|
58 |
58 |
$0.00 |