| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,078 |
1,878 |
$242K |
| D1110 |
Prophylaxis - adult |
3,272 |
2,961 |
$153K |
| D2160 |
|
1,214 |
867 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,355 |
3,227 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
4,095 |
3,690 |
$105K |
| D0272 |
Bitewings - two radiographic images |
3,915 |
3,547 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,708 |
3,334 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
379 |
367 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
594 |
580 |
$10K |
| D1120 |
Prophylaxis - child |
201 |
196 |
$7K |
| D2140 |
|
64 |
60 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
25 |
$3K |
| D0330 |
Panoramic radiographic image |
88 |
87 |
$3K |
| D1351 |
Sealant - per tooth |
32 |
12 |
$902.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
24 |
$356.25 |