| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,098 |
633 |
$87K |
| D1110 |
Prophylaxis - adult |
1,463 |
1,362 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,289 |
2,133 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
576 |
532 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,223 |
2,070 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
589 |
111 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,652 |
1,539 |
$40K |
| D2160 |
|
406 |
262 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,027 |
1,820 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,214 |
962 |
$31K |
| D1120 |
Prophylaxis - child |
870 |
805 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,784 |
1,634 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
511 |
442 |
$17K |
| D1351 |
Sealant - per tooth |
476 |
151 |
$13K |
| D2140 |
|
178 |
118 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
12 |
$5K |
| D0603 |
|
784 |
745 |
$4K |
| D0602 |
|
294 |
288 |
$1K |
| D0601 |
|
83 |
74 |
$415.00 |