| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,528 |
1,395 |
$234K |
| D1354 |
|
2,213 |
729 |
$137K |
| D0330 |
Panoramic radiographic image |
2,005 |
2,005 |
$95K |
| D1110 |
Prophylaxis - adult |
2,090 |
2,090 |
$94K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
723 |
305 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,946 |
3,946 |
$83K |
| D1120 |
Prophylaxis - child |
2,673 |
2,673 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,947 |
2,712 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,770 |
4,770 |
$72K |
| D2160 |
|
389 |
258 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,287 |
1,287 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,219 |
1,213 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,279 |
2,261 |
$34K |
| D2140 |
|
424 |
295 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,365 |
1,365 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
647 |
647 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,466 |
1,066 |
$19K |
| D0602 |
|
1,884 |
1,884 |
$17K |
| D1351 |
Sealant - per tooth |
667 |
229 |
$16K |
| D1320 |
|
277 |
234 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
14 |
$3K |
| D0350 |
|
75 |
75 |
$2K |
| D3120 |
|
31 |
25 |
$944.05 |
| D0601 |
|
73 |
73 |
$667.95 |
| D0603 |
|
58 |
58 |
$518.97 |