| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
593 |
314 |
$32K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
75 |
69 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
405 |
193 |
$23K |
| D2160 |
|
242 |
161 |
$16K |
| D0274 |
Bitewings - four radiographic images |
763 |
761 |
$15K |
| D2140 |
|
371 |
205 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
741 |
739 |
$12K |
| D1110 |
Prophylaxis - adult |
365 |
364 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
357 |
357 |
$9K |
| D2161 |
|
107 |
83 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,391 |
720 |
$7K |
| D2335 |
|
61 |
41 |
$6K |
| D0330 |
Panoramic radiographic image |
119 |
119 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
95 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
835 |
828 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
267 |
267 |
$4K |
| D2331 |
|
63 |
38 |
$4K |
| D1120 |
Prophylaxis - child |
161 |
161 |
$3K |
| D2330 |
|
59 |
40 |
$3K |
| D2332 |
|
20 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
62 |
$1K |
| D0272 |
Bitewings - two radiographic images |
80 |
80 |
$800.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$702.00 |