| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,448 |
744 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,039 |
1,039 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,213 |
1,213 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
878 |
878 |
$40K |
| D1110 |
Prophylaxis - adult |
465 |
463 |
$37K |
| D9110 |
|
544 |
494 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
278 |
180 |
$33K |
| D2160 |
|
404 |
270 |
$32K |
| D1120 |
Prophylaxis - child |
1,031 |
1,031 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,413 |
1,407 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,547 |
1,546 |
$17K |
| D2140 |
|
239 |
141 |
$13K |
| D0350 |
|
1,199 |
661 |
$12K |
| D0274 |
Bitewings - four radiographic images |
529 |
529 |
$11K |
| D4910 |
|
88 |
88 |
$7K |
| D0272 |
Bitewings - two radiographic images |
583 |
583 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
104 |
51 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
453 |
447 |
$5K |
| D4341 |
|
74 |
28 |
$4K |
| D2330 |
|
40 |
24 |
$3K |
| D2954 |
|
25 |
24 |
$3K |