| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,526 |
1,893 |
$197K |
| D1110 |
Prophylaxis - adult |
3,439 |
3,439 |
$174K |
| D1120 |
Prophylaxis - child |
4,888 |
4,888 |
$171K |
| D1206 |
Topical application of fluoride varnish |
9,435 |
9,435 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
6,497 |
6,497 |
$154K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,061 |
2,764 |
$100K |
| D0272 |
Bitewings - two radiographic images |
5,246 |
5,245 |
$100K |
| D0274 |
Bitewings - four radiographic images |
2,761 |
2,761 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,761 |
1,760 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
632 |
509 |
$69K |
| D0330 |
Panoramic radiographic image |
1,285 |
1,285 |
$55K |
| D2140 |
|
616 |
516 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
157 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
174 |
135 |
$19K |
| D2160 |
|
162 |
139 |
$15K |
| D1351 |
Sealant - per tooth |
335 |
100 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
690 |
670 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
25 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
44 |
$2K |