| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,170 |
597 |
$81K |
| D1110 |
Prophylaxis - adult |
1,260 |
1,159 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,924 |
1,804 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,873 |
1,734 |
$36K |
| D1120 |
Prophylaxis - child |
1,103 |
1,024 |
$32K |
| D2160 |
|
213 |
130 |
$15K |
| D0274 |
Bitewings - four radiographic images |
644 |
588 |
$13K |
| D0330 |
Panoramic radiographic image |
392 |
345 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
224 |
213 |
$11K |
| D2140 |
|
182 |
121 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
355 |
308 |
$8K |
| D0272 |
Bitewings - two radiographic images |
396 |
371 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
643 |
544 |
$6K |
| D1351 |
Sealant - per tooth |
102 |
25 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
70 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
56 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$380.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
45 |
25 |
$332.76 |