| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,377 |
2,044 |
$286K |
| D0120 |
Periodic oral evaluation - established patient |
4,581 |
4,532 |
$245K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,896 |
6,361 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,313 |
2,270 |
$139K |
| D1120 |
Prophylaxis - child |
3,398 |
3,335 |
$123K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
923 |
411 |
$107K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
161 |
131 |
$76K |
| D0274 |
Bitewings - four radiographic images |
3,465 |
3,453 |
$67K |
| D2140 |
|
1,141 |
697 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
887 |
570 |
$58K |
| D1110 |
Prophylaxis - adult |
622 |
619 |
$52K |
| D2160 |
|
632 |
421 |
$48K |
| D4341 |
|
671 |
225 |
$47K |
| D1206 |
Topical application of fluoride varnish |
3,993 |
3,946 |
$47K |
| D4910 |
|
417 |
417 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
508 |
507 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,992 |
1,935 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
284 |
173 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
200 |
99 |
$11K |
| D1351 |
Sealant - per tooth |
416 |
108 |
$9K |
| D7230 |
|
41 |
24 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
71 |
$8K |
| D0350 |
|
702 |
643 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
516 |
514 |
$6K |
| D1320 |
|
310 |
308 |
$5K |
| D9430 |
|
36 |
36 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$390.00 |
| D1999 |
|
1,097 |
1,086 |
$103.14 |