| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,974 |
1,075 |
$132K |
| D1110 |
Prophylaxis - adult |
1,225 |
1,223 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,481 |
1,479 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,471 |
1,470 |
$82K |
| D1120 |
Prophylaxis - child |
1,747 |
1,745 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,198 |
1,198 |
$57K |
| D2160 |
|
607 |
408 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,580 |
1,650 |
$38K |
| D2140 |
|
681 |
430 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,134 |
3,130 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,197 |
1,195 |
$25K |
| D0350 |
|
1,000 |
663 |
$9K |
| D1351 |
Sealant - per tooth |
272 |
70 |
$7K |
| D1310 |
|
56 |
56 |
$2K |
| D9993 |
|
32 |
32 |
$2K |
| D0603 |
|
57 |
56 |
$795.00 |
| D0272 |
Bitewings - two radiographic images |
53 |
53 |
$636.00 |
| D9430 |
|
13 |
12 |
$416.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$168.00 |