| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2140 |
|
5,356 |
1,784 |
$155K |
| D2331 |
|
1,942 |
814 |
$90K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,991 |
1,281 |
$75K |
| D1110 |
Prophylaxis - adult |
1,625 |
1,540 |
$49K |
| D2332 |
|
695 |
406 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,141 |
1,070 |
$22K |
| D1999 |
|
1,535 |
1,416 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,049 |
1,004 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,578 |
1,314 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,194 |
1,122 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
354 |
348 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
26 |
$374.01 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
15 |
$373.71 |
| D2950 |
|
180 |
76 |
$0.00 |
| D6750 |
|
63 |
25 |
$0.00 |
| D6240 |
|
47 |
25 |
$0.00 |
| D2750 |
|
29 |
13 |
$0.00 |