| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,248 |
1,577 |
$222K |
| D1110 |
Prophylaxis - adult |
3,001 |
3,001 |
$137K |
| D0330 |
Panoramic radiographic image |
2,293 |
2,293 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
5,270 |
5,270 |
$111K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
844 |
525 |
$107K |
| D0140 |
Limited oral evaluation - problem focused |
3,144 |
2,906 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,357 |
584 |
$91K |
| D1120 |
Prophylaxis - child |
2,673 |
2,673 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,830 |
2,590 |
$76K |
| D1351 |
Sealant - per tooth |
2,977 |
788 |
$71K |
| D2140 |
|
1,165 |
856 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,271 |
2,271 |
$70K |
| D2160 |
|
458 |
380 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
4,327 |
4,117 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,809 |
3,808 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
843 |
843 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,215 |
1,986 |
$17K |
| D0272 |
Bitewings - two radiographic images |
888 |
888 |
$16K |
| D1206 |
Topical application of fluoride varnish |
679 |
679 |
$13K |
| D5110 |
|
15 |
15 |
$11K |
| D7111 |
|
159 |
116 |
$9K |
| D5120 |
|
12 |
12 |
$9K |
| D7250 |
|
18 |
12 |
$2K |