| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,595 |
1,180 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,747 |
1,744 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,627 |
2,919 |
$64K |
| D2740 |
Crown - porcelain/ceramic |
126 |
86 |
$60K |
| D1120 |
Prophylaxis - child |
1,387 |
1,384 |
$54K |
| D2140 |
|
751 |
413 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
625 |
625 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,550 |
1,548 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,239 |
2,234 |
$32K |
| D0350 |
|
1,769 |
1,300 |
$31K |
| D1110 |
Prophylaxis - adult |
332 |
331 |
$29K |
| D1351 |
Sealant - per tooth |
671 |
174 |
$20K |
| D4341 |
|
165 |
67 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
884 |
793 |
$10K |
| D0272 |
Bitewings - two radiographic images |
195 |
195 |
$2K |
| D4910 |
|
25 |
25 |
$2K |
| D2160 |
|
14 |
12 |
$1K |