| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,516 |
955 |
$128K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
997 |
599 |
$120K |
| D1110 |
Prophylaxis - adult |
2,525 |
2,336 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,447 |
2,132 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,069 |
573 |
$73K |
| D2160 |
|
702 |
514 |
$69K |
| D0330 |
Panoramic radiographic image |
1,381 |
1,319 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,601 |
1,488 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,717 |
1,604 |
$44K |
| D2140 |
|
635 |
455 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
442 |
281 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
1,064 |
861 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,793 |
1,746 |
$34K |
| D0274 |
Bitewings - four radiographic images |
885 |
678 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,146 |
1,139 |
$22K |
| D1120 |
Prophylaxis - child |
517 |
516 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,299 |
1,152 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
904 |
537 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
36 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
140 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
38 |
12 |
$943.87 |