| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,700 |
1,132 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
2,346 |
2,329 |
$69K |
| D1120 |
Prophylaxis - child |
2,260 |
2,241 |
$67K |
| D2140 |
|
1,071 |
772 |
$55K |
| D1110 |
Prophylaxis - adult |
628 |
622 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
862 |
465 |
$44K |
| D2160 |
|
306 |
247 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,393 |
1,376 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,095 |
2,075 |
$18K |
| D0330 |
Panoramic radiographic image |
710 |
700 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
371 |
357 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
308 |
302 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,061 |
1,035 |
$12K |
| D2330 |
|
120 |
80 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,830 |
983 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
83 |
$5K |
| D0272 |
Bitewings - two radiographic images |
228 |
226 |
$3K |
| D4341 |
|
33 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
197 |
197 |
$2K |
| D0350 |
|
68 |
67 |
$570.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$0.00 |