| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
591 |
262 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,646 |
1,031 |
$43K |
| D1120 |
Prophylaxis - child |
1,104 |
675 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
220 |
67 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,139 |
712 |
$27K |
| D1110 |
Prophylaxis - adult |
521 |
340 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,232 |
760 |
$24K |
| D2140 |
|
329 |
145 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
208 |
136 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
711 |
416 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
423 |
236 |
$11K |
| D1351 |
Sealant - per tooth |
314 |
80 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
524 |
319 |
$7K |
| D1206 |
Topical application of fluoride varnish |
320 |
215 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
173 |
111 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
12 |
$3K |
| D2160 |
|
21 |
13 |
$2K |
| D0602 |
|
593 |
343 |
$609.58 |
| D0603 |
|
497 |
281 |
$399.01 |
| D0601 |
|
44 |
29 |
$75.28 |