| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,904 |
1,372 |
$199K |
| D1110 |
Prophylaxis - adult |
3,716 |
3,507 |
$168K |
| D2160 |
|
1,549 |
726 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
3,679 |
3,494 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,274 |
2,137 |
$71K |
| D1206 |
Topical application of fluoride varnish |
2,329 |
2,191 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,440 |
1,334 |
$47K |
| D2140 |
|
726 |
449 |
$40K |
| D1120 |
Prophylaxis - child |
1,297 |
1,228 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,510 |
1,412 |
$25K |
| D0330 |
Panoramic radiographic image |
333 |
315 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
321 |
249 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
722 |
673 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
191 |
178 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
40 |
$5K |
| D2161 |
|
41 |
26 |
$4K |
| D7962 |
|
14 |
12 |
$2K |
| D2332 |
|
17 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
51 |
44 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
204 |
168 |
$2K |
| D0272 |
Bitewings - two radiographic images |
39 |
38 |
$901.01 |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
29 |
$819.79 |