| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2332 |
|
8,290 |
1,273 |
$480K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,372 |
1,112 |
$180K |
| D1120 |
Prophylaxis - child |
2,276 |
2,229 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,883 |
2,835 |
$42K |
| D1110 |
Prophylaxis - adult |
1,311 |
1,279 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,263 |
2,217 |
$27K |
| D1351 |
Sealant - per tooth |
1,711 |
368 |
$25K |
| D2161 |
|
463 |
268 |
$22K |
| D9110 |
|
927 |
806 |
$21K |
| D2160 |
|
402 |
212 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,570 |
1,534 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,114 |
2,011 |
$15K |
| D2335 |
|
215 |
107 |
$13K |
| D2140 |
|
368 |
195 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
430 |
418 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,373 |
1,298 |
$8K |
| D0330 |
Panoramic radiographic image |
114 |
113 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
16 |
$3K |
| D7111 |
|
20 |
13 |
$800.18 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$404.00 |