| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,231 |
755 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,210 |
1,206 |
$72K |
| D1110 |
Prophylaxis - adult |
852 |
850 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
389 |
268 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
978 |
976 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
723 |
722 |
$31K |
| D1120 |
Prophylaxis - child |
633 |
629 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,037 |
1,007 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
233 |
85 |
$13K |
| D2140 |
|
241 |
176 |
$13K |
| D0274 |
Bitewings - four radiographic images |
607 |
607 |
$13K |
| D2160 |
|
68 |
56 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
523 |
520 |
$4K |
| D2330 |
|
22 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$156.00 |