| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2140 |
|
797 |
415 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
584 |
335 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,503 |
1,378 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,409 |
1,306 |
$18K |
| D1110 |
Prophylaxis - adult |
608 |
547 |
$17K |
| D1351 |
Sealant - per tooth |
876 |
211 |
$17K |
| D1120 |
Prophylaxis - child |
876 |
815 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
637 |
497 |
$12K |
| D9248 |
|
423 |
374 |
$10K |
| D0272 |
Bitewings - two radiographic images |
525 |
479 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
96 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
14 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
29 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
61 |
54 |
$720.48 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
12 |
$284.00 |