| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,253 |
539 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,574 |
2,793 |
$89K |
| D1110 |
Prophylaxis - adult |
1,738 |
1,376 |
$78K |
| D1206 |
Topical application of fluoride varnish |
3,284 |
2,570 |
$62K |
| D0272 |
Bitewings - two radiographic images |
2,664 |
2,079 |
$60K |
| D1120 |
Prophylaxis - child |
1,753 |
1,356 |
$58K |
| D2140 |
|
639 |
299 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,596 |
1,092 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,681 |
1,242 |
$27K |
| D2160 |
|
246 |
101 |
$23K |
| D7111 |
|
417 |
160 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,316 |
968 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
167 |
145 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
77 |
38 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
109 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
14 |
$3K |
| D0603 |
|
663 |
626 |
$3K |
| D1351 |
Sealant - per tooth |
88 |
26 |
$2K |
| D0602 |
|
245 |
234 |
$1K |