| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,942 |
2,079 |
$255K |
| D1110 |
Prophylaxis - adult |
4,612 |
4,479 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
8,857 |
8,589 |
$176K |
| D1120 |
Prophylaxis - child |
4,647 |
4,495 |
$137K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,607 |
7,354 |
$128K |
| D1351 |
Sealant - per tooth |
5,917 |
1,688 |
$118K |
| D0274 |
Bitewings - four radiographic images |
4,437 |
4,268 |
$115K |
| D2140 |
|
1,470 |
951 |
$72K |
| D2160 |
|
868 |
528 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,258 |
1,951 |
$40K |
| D0330 |
Panoramic radiographic image |
565 |
543 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,935 |
1,802 |
$21K |
| D2740 |
Crown - porcelain/ceramic |
36 |
29 |
$16K |
| D1206 |
Topical application of fluoride varnish |
845 |
817 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
491 |
466 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
446 |
414 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
73 |
28 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
128 |
120 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
53 |
$6K |
| D2332 |
|
115 |
42 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
555 |
247 |
$5K |
| D2950 |
|
24 |
13 |
$3K |