| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,273 |
1,185 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
5,001 |
4,776 |
$92K |
| D1110 |
Prophylaxis - adult |
2,463 |
2,388 |
$90K |
| D1120 |
Prophylaxis - child |
2,879 |
2,724 |
$79K |
| D1351 |
Sealant - per tooth |
3,831 |
955 |
$77K |
| D2740 |
Crown - porcelain/ceramic |
186 |
143 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,629 |
2,499 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,960 |
3,811 |
$64K |
| D2160 |
|
567 |
330 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,528 |
1,306 |
$28K |
| D2950 |
|
240 |
170 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,496 |
1,413 |
$23K |
| D2140 |
|
397 |
253 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,647 |
1,548 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
529 |
502 |
$13K |
| D4910 |
|
142 |
140 |
$9K |
| D2332 |
|
121 |
51 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
242 |
234 |
$6K |
| D0330 |
Panoramic radiographic image |
54 |
53 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
294 |
153 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$1K |