| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2140 |
|
428 |
130 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
266 |
116 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
379 |
302 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
260 |
256 |
$10K |
| D9430 |
|
156 |
130 |
$4K |
| D0350 |
|
410 |
149 |
$2K |
| D1120 |
Prophylaxis - child |
64 |
61 |
$2K |
| D1110 |
Prophylaxis - adult |
52 |
49 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
153 |
151 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
261 |
117 |
$807.00 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
30 |
$280.00 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
13 |
$231.00 |
| D3120 |
|
22 |
14 |
$0.00 |