| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,112 |
2,600 |
$244K |
| D1120 |
Prophylaxis - child |
6,619 |
6,619 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
7,557 |
7,557 |
$179K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,414 |
5,084 |
$177K |
| D1206 |
Topical application of fluoride varnish |
9,409 |
9,409 |
$155K |
| D0272 |
Bitewings - two radiographic images |
6,933 |
6,933 |
$132K |
| D1110 |
Prophylaxis - adult |
1,751 |
1,751 |
$89K |
| D0330 |
Panoramic radiographic image |
1,623 |
1,623 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,262 |
1,262 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,582 |
1,582 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
253 |
207 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
206 |
170 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,269 |
1,260 |
$16K |
| D2140 |
|
241 |
217 |
$15K |
| D2160 |
|
113 |
106 |
$11K |
| D1351 |
Sealant - per tooth |
255 |
80 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
264 |
250 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$1K |