| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,223 |
635 |
$91K |
| D1110 |
Prophylaxis - adult |
1,750 |
1,716 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,645 |
2,598 |
$67K |
| D0272 |
Bitewings - two radiographic images |
2,414 |
2,371 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,127 |
2,099 |
$41K |
| D2160 |
|
447 |
254 |
$39K |
| D1120 |
Prophylaxis - child |
877 |
864 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
438 |
227 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
293 |
290 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,514 |
1,319 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
649 |
625 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
680 |
569 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
725 |
439 |
$7K |
| D1206 |
Topical application of fluoride varnish |
123 |
118 |
$2K |
| D2161 |
|
14 |
12 |
$2K |
| D0601 |
|
259 |
257 |
$1K |
| D2140 |
|
17 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
30 |
$923.40 |
| D0330 |
Panoramic radiographic image |
51 |
50 |
$501.60 |
| D0603 |
|
83 |
83 |
$385.00 |