| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
967 |
431 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,620 |
1,608 |
$42K |
| D1110 |
Prophylaxis - adult |
876 |
868 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,227 |
1,217 |
$29K |
| D1120 |
Prophylaxis - child |
846 |
842 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
315 |
313 |
$27K |
| D2160 |
|
162 |
103 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
573 |
571 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
216 |
202 |
$4K |
| D2140 |
|
41 |
24 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
15 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
57 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
19 |
$581.40 |