| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,467 |
704 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,356 |
2,348 |
$92K |
| D1120 |
Prophylaxis - child |
2,233 |
2,227 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,124 |
2,720 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
565 |
565 |
$33K |
| D2160 |
|
392 |
232 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
226 |
135 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,638 |
2,632 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
411 |
213 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
370 |
368 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,315 |
1,313 |
$15K |
| D0274 |
Bitewings - four radiographic images |
706 |
704 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,240 |
1,200 |
$14K |
| D1110 |
Prophylaxis - adult |
155 |
155 |
$13K |
| D0350 |
|
1,327 |
766 |
$12K |
| D2140 |
|
218 |
139 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
204 |
108 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
137 |
83 |
$9K |
| D1351 |
Sealant - per tooth |
283 |
75 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
24 |
12 |
$3K |
| D9993 |
|
39 |
39 |
$3K |
| D1310 |
|
39 |
39 |
$2K |
| D2330 |
|
21 |
12 |
$2K |
| D9430 |
|
75 |
75 |
$2K |
| D2161 |
|
14 |
13 |
$1K |