| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,708 |
1,232 |
$216K |
| D2140 |
|
3,043 |
1,157 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
3,544 |
3,290 |
$93K |
| D1120 |
Prophylaxis - child |
2,072 |
1,903 |
$74K |
| D1110 |
Prophylaxis - adult |
1,482 |
1,388 |
$70K |
| D1206 |
Topical application of fluoride varnish |
3,202 |
2,955 |
$63K |
| D0272 |
Bitewings - two radiographic images |
2,564 |
2,378 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,322 |
2,993 |
$56K |
| D0240 |
|
2,273 |
2,104 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,677 |
1,503 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
462 |
422 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
509 |
450 |
$17K |
| D2160 |
|
121 |
81 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
626 |
580 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
57 |
$7K |
| D0602 |
|
869 |
831 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
196 |
195 |
$4K |
| D0603 |
|
560 |
551 |
$3K |
| D0601 |
|
209 |
191 |
$1K |