| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,918 |
1,808 |
$376K |
| D0120 |
Periodic oral evaluation - established patient |
6,800 |
6,735 |
$196K |
| D1110 |
Prophylaxis - adult |
3,790 |
3,751 |
$190K |
| D1120 |
Prophylaxis - child |
4,971 |
4,925 |
$183K |
| D0330 |
Panoramic radiographic image |
2,451 |
2,416 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,803 |
6,738 |
$141K |
| D1351 |
Sealant - per tooth |
3,505 |
1,236 |
$105K |
| D0272 |
Bitewings - two radiographic images |
4,652 |
4,609 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,032 |
1,015 |
$48K |
| D2140 |
|
660 |
330 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
1,811 |
1,754 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
381 |
377 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
122 |
$11K |
| D2160 |
|
57 |
40 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$165.00 |