| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,519 |
795 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,388 |
573 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,334 |
1,325 |
$74K |
| D2160 |
|
868 |
560 |
$69K |
| D1110 |
Prophylaxis - adult |
616 |
611 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,305 |
1,891 |
$32K |
| D1120 |
Prophylaxis - child |
976 |
965 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
668 |
664 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
484 |
481 |
$22K |
| D0274 |
Bitewings - four radiographic images |
991 |
987 |
$20K |
| D9430 |
|
452 |
450 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,042 |
1,036 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
92 |
69 |
$10K |
| D2140 |
|
68 |
52 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
255 |
249 |
$2K |
| D0272 |
Bitewings - two radiographic images |
131 |
131 |
$1K |