| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14,203 |
4,539 |
$574K |
| D2140 |
|
18,031 |
4,711 |
$563K |
| D1110 |
Prophylaxis - adult |
15,205 |
11,897 |
$413K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,624 |
1,277 |
$367K |
| D2332 |
|
4,347 |
601 |
$274K |
| D1999 |
|
16,621 |
12,146 |
$247K |
| D2330 |
|
7,099 |
1,316 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
12,967 |
10,178 |
$182K |
| D0272 |
Bitewings - two radiographic images |
10,642 |
8,376 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,291 |
5,693 |
$143K |
| D0330 |
Panoramic radiographic image |
4,482 |
3,289 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,539 |
5,205 |
$135K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,300 |
1,345 |
$122K |
| D2160 |
|
2,412 |
1,457 |
$107K |
| D2331 |
|
2,185 |
532 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
7,403 |
6,098 |
$54K |
| D2335 |
|
531 |
262 |
$32K |
| D2161 |
|
584 |
376 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,493 |
1,151 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,001 |
1,732 |
$18K |
| D1120 |
Prophylaxis - child |
1,427 |
1,270 |
$14K |
| D3320 |
|
33 |
24 |
$6K |
| D2940 |
|
90 |
71 |
$2K |