| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,858 |
2,470 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,015 |
959 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
3,750 |
3,258 |
$29K |
| D1120 |
Prophylaxis - child |
3,622 |
3,496 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
5,644 |
5,405 |
$21K |
| D1110 |
Prophylaxis - adult |
2,229 |
2,122 |
$20K |
| D1206 |
Topical application of fluoride varnish |
7,783 |
7,482 |
$18K |
| D2160 |
|
686 |
457 |
$12K |
| D0274 |
Bitewings - four radiographic images |
2,864 |
2,757 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,279 |
2,192 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
621 |
375 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
683 |
665 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
3,332 |
2,918 |
$6K |
| D2140 |
|
741 |
448 |
$6K |
| D2940 |
|
468 |
369 |
$5K |
| D2331 |
|
220 |
142 |
$4K |
| D1320 |
|
2,281 |
2,161 |
$3K |
| D1351 |
Sealant - per tooth |
631 |
226 |
$2K |
| D1354 |
|
7,824 |
3,202 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
983 |
413 |
$828.00 |
| D1999 |
|
743 |
623 |
$553.00 |
| D2330 |
|
27 |
14 |
$522.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
14 |
$355.00 |
| D0272 |
Bitewings - two radiographic images |
69 |
69 |
$324.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
37 |
$260.00 |
| D0603 |
|
942 |
877 |
$176.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$154.00 |
| D0601 |
|
2,144 |
2,049 |
$143.00 |
| D0602 |
|
989 |
939 |
$88.00 |
| D1330 |
|
7,498 |
7,200 |
$52.45 |
| D0270 |
|
14 |
14 |
$33.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
499 |
499 |
$0.00 |
| D1310 |
|
18 |
18 |
$0.00 |
| D0191 |
|
1,024 |
1,021 |
$0.00 |