| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,189 |
841 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,728 |
3,715 |
$99K |
| D1110 |
Prophylaxis - adult |
2,080 |
2,071 |
$97K |
| D1120 |
Prophylaxis - child |
2,411 |
2,401 |
$81K |
| D2140 |
|
1,160 |
850 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,059 |
1,753 |
$73K |
| D0330 |
Panoramic radiographic image |
1,152 |
1,149 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,147 |
3,137 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,553 |
2,535 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
809 |
564 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,007 |
991 |
$45K |
| D1351 |
Sealant - per tooth |
1,554 |
465 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,568 |
2,423 |
$35K |
| D2160 |
|
301 |
256 |
$30K |
| D9945 |
|
105 |
101 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,319 |
1,237 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
851 |
672 |
$9K |
| D9940 |
|
16 |
16 |
$5K |
| D3110 |
|
109 |
72 |
$3K |