| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,662 |
1,237 |
$120K |
| D1110 |
Prophylaxis - adult |
4,401 |
3,630 |
$120K |
| D1999 |
|
7,578 |
5,206 |
$112K |
| D2140 |
|
1,799 |
746 |
$61K |
| D2160 |
|
967 |
526 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,416 |
2,037 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
874 |
504 |
$48K |
| D0272 |
Bitewings - two radiographic images |
3,244 |
2,663 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,503 |
2,022 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
768 |
216 |
$33K |
| D0330 |
Panoramic radiographic image |
995 |
730 |
$30K |
| D2330 |
|
747 |
235 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
753 |
599 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
851 |
684 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,217 |
1,114 |
$10K |
| D2335 |
|
134 |
49 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
604 |
480 |
$5K |
| D2332 |
|
52 |
14 |
$3K |
| D1120 |
Prophylaxis - child |
154 |
139 |
$3K |
| D2161 |
|
30 |
12 |
$2K |