| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
343 |
337 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
238 |
103 |
$16K |
| D1120 |
Prophylaxis - child |
473 |
464 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,615 |
527 |
$10K |
| D2140 |
|
157 |
63 |
$9K |
| D1351 |
Sealant - per tooth |
377 |
102 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
514 |
505 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
134 |
133 |
$4K |
| D0272 |
Bitewings - two radiographic images |
227 |
224 |
$2K |
| D0350 |
|
207 |
107 |
$2K |
| D0274 |
Bitewings - four radiographic images |
87 |
87 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
34 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
15 |
$1K |
| D2160 |
|
17 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
17 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
85 |
81 |
$992.00 |
| D9430 |
|
14 |
13 |
$448.00 |