| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,100 |
810 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
5,801 |
5,059 |
$152K |
| D1110 |
Prophylaxis - adult |
2,921 |
2,573 |
$139K |
| D2140 |
|
1,961 |
698 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,116 |
5,367 |
$120K |
| D1120 |
Prophylaxis - child |
2,997 |
2,619 |
$106K |
| D0272 |
Bitewings - two radiographic images |
3,896 |
3,473 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
965 |
857 |
$83K |
| D1351 |
Sealant - per tooth |
2,140 |
670 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
2,637 |
2,214 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
424 |
160 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
183 |
63 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
724 |
621 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
403 |
156 |
$23K |
| D0330 |
Panoramic radiographic image |
723 |
701 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
274 |
160 |
$19K |
| D0603 |
|
3,158 |
2,760 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
908 |
743 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
320 |
312 |
$11K |
| D0601 |
|
1,449 |
1,263 |
$7K |
| D0602 |
|
916 |
805 |
$5K |
| D7111 |
|
61 |
48 |
$3K |
| D2160 |
|
26 |
12 |
$2K |
| D1354 |
|
40 |
13 |
$600.00 |