| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
618 |
474 |
$94K |
| D0274 |
Bitewings - four radiographic images |
1,507 |
1,482 |
$70K |
| D1120 |
Prophylaxis - child |
1,144 |
1,111 |
$70K |
| D1206 |
Topical application of fluoride varnish |
1,734 |
1,678 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
1,287 |
1,254 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
605 |
576 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
579 |
516 |
$51K |
| D0330 |
Panoramic radiographic image |
543 |
533 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
518 |
266 |
$47K |
| D1110 |
Prophylaxis - adult |
324 |
322 |
$27K |
| D2140 |
|
230 |
180 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
376 |
360 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
687 |
657 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
91 |
65 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
493 |
326 |
$16K |
| D1351 |
Sealant - per tooth |
278 |
103 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
28 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
34 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
31 |
31 |
$952.68 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$261.00 |