| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,923 |
991 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
2,890 |
2,863 |
$84K |
| D1120 |
Prophylaxis - child |
2,393 |
2,373 |
$73K |
| D1206 |
Topical application of fluoride varnish |
2,313 |
2,290 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,813 |
1,780 |
$60K |
| D0272 |
Bitewings - two radiographic images |
1,819 |
1,785 |
$49K |
| D1110 |
Prophylaxis - adult |
1,258 |
1,234 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,412 |
3,254 |
$38K |
| D0330 |
Panoramic radiographic image |
961 |
939 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
896 |
877 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,690 |
2,729 |
$30K |
| D2140 |
|
608 |
429 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
650 |
603 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
115 |
70 |
$10K |
| D1351 |
Sealant - per tooth |
220 |
73 |
$9K |
| D2160 |
|
156 |
112 |
$8K |
| D2331 |
|
31 |
24 |
$2K |