| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,683 |
1,150 |
$190K |
| D1110 |
Prophylaxis - adult |
2,435 |
2,405 |
$101K |
| D2140 |
|
1,694 |
835 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,453 |
4,414 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,565 |
3,524 |
$84K |
| D1120 |
Prophylaxis - child |
2,439 |
2,414 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,715 |
2,685 |
$71K |
| D0330 |
Panoramic radiographic image |
1,345 |
1,333 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,576 |
1,562 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
609 |
277 |
$41K |
| D2950 |
|
217 |
155 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,428 |
2,050 |
$25K |
| D2160 |
|
223 |
133 |
$18K |
| D0272 |
Bitewings - two radiographic images |
992 |
982 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
544 |
534 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
19 |
16 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
13 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
51 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
804 |
473 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
134 |
107 |
$4K |
| D1351 |
Sealant - per tooth |
77 |
25 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$1K |
| D1999 |
|
60 |
49 |
$0.00 |