| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,534 |
1,112 |
$272K |
| D1110 |
Prophylaxis - adult |
3,317 |
3,105 |
$222K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,951 |
2,649 |
$179K |
| D0210 |
Intraoral - complete series of radiographic images |
1,572 |
1,424 |
$137K |
| D4355 |
|
860 |
775 |
$131K |
| D0330 |
Panoramic radiographic image |
1,576 |
1,442 |
$111K |
| D0274 |
Bitewings - four radiographic images |
2,332 |
2,189 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
2,433 |
2,301 |
$97K |
| D2160 |
|
365 |
297 |
$83K |
| D1206 |
Topical application of fluoride varnish |
2,465 |
2,365 |
$78K |
| D2140 |
|
522 |
402 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
1,390 |
1,250 |
$73K |
| D4341 |
|
221 |
104 |
$49K |
| D1120 |
Prophylaxis - child |
731 |
698 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,661 |
1,491 |
$33K |
| D2335 |
|
34 |
24 |
$12K |
| D2331 |
|
19 |
13 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
170 |
144 |
$2K |
| D0603 |
|
1,732 |
1,648 |
$0.00 |
| D0601 |
|
117 |
112 |
$0.00 |