| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,214 |
1,660 |
$613K |
| D1351 |
Sealant - per tooth |
11,646 |
1,919 |
$337K |
| D0220 |
Intraoral - periapical first radiographic image |
6,019 |
3,100 |
$244K |
| D1110 |
Prophylaxis - adult |
3,657 |
3,586 |
$190K |
| D0274 |
Bitewings - four radiographic images |
3,832 |
3,770 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,737 |
3,676 |
$134K |
| D1206 |
Topical application of fluoride varnish |
2,961 |
2,924 |
$109K |
| D9110 |
|
1,894 |
1,723 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
2,918 |
2,867 |
$96K |
| D0330 |
Panoramic radiographic image |
1,517 |
1,486 |
$91K |
| D1120 |
Prophylaxis - child |
1,878 |
1,853 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
712 |
345 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,343 |
1,256 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
730 |
712 |
$32K |
| D4355 |
|
351 |
346 |
$30K |
| D2331 |
|
188 |
66 |
$20K |
| D2140 |
|
223 |
150 |
$16K |
| D0170 |
|
477 |
428 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
67 |
$8K |
| D1330 |
|
845 |
839 |
$7K |
| D4346 |
|
78 |
78 |
$7K |
| D2330 |
|
23 |
12 |
$2K |
| D0160 |
|
12 |
12 |
$468.00 |
| D9986 |
|
40 |
36 |
$0.00 |