| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
200 |
99 |
$11K |
| D0274 |
Bitewings - four radiographic images |
552 |
542 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
351 |
346 |
$9K |
| D1110 |
Prophylaxis - adult |
255 |
251 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
76 |
$8K |
| D2160 |
|
115 |
90 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
69 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
393 |
387 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
41 |
$4K |
| D0330 |
Panoramic radiographic image |
87 |
85 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$1K |
| D2140 |
|
35 |
26 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
268 |
259 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
61 |
61 |
$915.00 |
| D0140 |
Limited oral evaluation - problem focused |
35 |
32 |
$742.14 |
| D1120 |
Prophylaxis - child |
26 |
26 |
$520.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
37 |
$280.00 |