| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
806 |
357 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,977 |
1,921 |
$50K |
| D1110 |
Prophylaxis - adult |
1,048 |
1,032 |
$47K |
| D1120 |
Prophylaxis - child |
1,030 |
1,000 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,477 |
1,439 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
339 |
329 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,028 |
1,003 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
497 |
478 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
52 |
$6K |
| D2160 |
|
48 |
26 |
$4K |
| D1351 |
Sealant - per tooth |
123 |
37 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
106 |
99 |
$1K |
| D1999 |
|
33 |
30 |
$0.00 |