| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,411 |
728 |
$60K |
| D2140 |
|
1,057 |
522 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
756 |
284 |
$31K |
| D1110 |
Prophylaxis - adult |
955 |
941 |
$30K |
| D0330 |
Panoramic radiographic image |
655 |
638 |
$23K |
| D2160 |
|
432 |
296 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,019 |
1,000 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
866 |
853 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
799 |
728 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
745 |
732 |
$13K |
| D1120 |
Prophylaxis - child |
530 |
528 |
$9K |
| D1206 |
Topical application of fluoride varnish |
138 |
137 |
$2K |
| D0272 |
Bitewings - two radiographic images |
74 |
74 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
100 |
95 |
$1K |
| D4355 |
|
29 |
25 |
$509.04 |
| D9985 |
|
24 |
23 |
$0.00 |