| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
990 |
278 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
620 |
327 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
616 |
615 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
788 |
785 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
719 |
717 |
$27K |
| D0350 |
|
2,021 |
796 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
168 |
100 |
$19K |
| D1120 |
Prophylaxis - child |
454 |
452 |
$13K |
| D2160 |
|
134 |
95 |
$10K |
| D5750 |
|
48 |
47 |
$9K |
| D1110 |
Prophylaxis - adult |
97 |
97 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
137 |
83 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
644 |
641 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,477 |
534 |
$6K |
| D2140 |
|
105 |
61 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
39 |
$5K |
| D5751 |
|
18 |
18 |
$3K |
| D0274 |
Bitewings - four radiographic images |
149 |
149 |
$3K |
| D1351 |
Sealant - per tooth |
109 |
26 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
54 |
54 |
$640.00 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
24 |
$300.00 |