| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,276 |
1,739 |
$393K |
| D2160 |
|
1,664 |
880 |
$182K |
| D1110 |
Prophylaxis - adult |
2,999 |
2,961 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
4,920 |
4,894 |
$137K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,092 |
2,795 |
$114K |
| D1120 |
Prophylaxis - child |
2,564 |
2,550 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,985 |
3,969 |
$81K |
| D0272 |
Bitewings - two radiographic images |
3,679 |
3,609 |
$73K |
| D2140 |
|
651 |
391 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
778 |
728 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
401 |
189 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,875 |
1,807 |
$24K |
| D0330 |
Panoramic radiographic image |
170 |
164 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
335 |
326 |
$5K |
| D1351 |
Sealant - per tooth |
164 |
68 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
479 |
313 |
$3K |
| D2161 |
|
23 |
12 |
$3K |