| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
322 |
208 |
$57K |
| D1120 |
Prophylaxis - child |
846 |
829 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,271 |
1,247 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,025 |
1,004 |
$48K |
| D1110 |
Prophylaxis - adult |
474 |
467 |
$40K |
| D0274 |
Bitewings - four radiographic images |
578 |
569 |
$35K |
| D0272 |
Bitewings - two radiographic images |
722 |
707 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
88 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
290 |
286 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
423 |
275 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
541 |
533 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
39 |
$13K |
| D1351 |
Sealant - per tooth |
225 |
67 |
$12K |
| D0330 |
Panoramic radiographic image |
97 |
97 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
121 |
109 |
$10K |
| D2140 |
|
33 |
26 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$952.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$857.00 |