| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,734 |
1,033 |
$133K |
| D1110 |
Prophylaxis - adult |
2,481 |
2,340 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
4,101 |
3,818 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,297 |
476 |
$89K |
| D0272 |
Bitewings - two radiographic images |
3,575 |
3,363 |
$77K |
| D2160 |
|
847 |
500 |
$76K |
| D1206 |
Topical application of fluoride varnish |
3,932 |
3,683 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,774 |
2,284 |
$66K |
| D1120 |
Prophylaxis - child |
1,684 |
1,570 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
726 |
644 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
733 |
654 |
$22K |
| D2140 |
|
206 |
138 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
499 |
472 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
44 |
28 |
$6K |
| D0330 |
Panoramic radiographic image |
355 |
334 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
126 |
125 |
$4K |
| D7111 |
|
27 |
12 |
$1K |