| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,164 |
2,100 |
$62K |
| D2954 |
|
277 |
191 |
$37K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
782 |
328 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
2,008 |
1,947 |
$19K |
| D0274 |
Bitewings - four radiographic images |
839 |
812 |
$18K |
| D0330 |
Panoramic radiographic image |
368 |
361 |
$11K |
| D3310 |
|
62 |
39 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
273 |
267 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
428 |
419 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
201 |
56 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
660 |
645 |
$6K |
| D5211 |
|
30 |
30 |
$6K |
| D2160 |
|
111 |
80 |
$5K |
| D5212 |
|
12 |
12 |
$2K |
| D2950 |
|
23 |
14 |
$2K |
| D2140 |
|
85 |
38 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
285 |
207 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
101 |
100 |
$990.00 |