| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,600 |
890 |
$153K |
| D1354 |
|
1,824 |
472 |
$137K |
| D1120 |
Prophylaxis - child |
2,184 |
2,184 |
$65K |
| D1110 |
Prophylaxis - adult |
1,282 |
1,282 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,169 |
1,914 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,707 |
2,707 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,565 |
3,565 |
$53K |
| D0330 |
Panoramic radiographic image |
1,052 |
1,052 |
$50K |
| D0274 |
Bitewings - four radiographic images |
962 |
962 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,542 |
1,525 |
$23K |
| D2160 |
|
166 |
88 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
511 |
510 |
$15K |
| D0272 |
Bitewings - two radiographic images |
745 |
745 |
$13K |
| D2140 |
|
141 |
100 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
277 |
277 |
$8K |
| D0602 |
|
620 |
620 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
25 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
178 |
108 |
$1K |
| D0601 |
|
90 |
90 |
$823.50 |
| D1351 |
Sealant - per tooth |
30 |
12 |
$731.70 |
| D3120 |
|
20 |
14 |
$564.00 |
| D0603 |
|
36 |
36 |
$304.56 |