| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,189 |
747 |
$67K |
| D1110 |
Prophylaxis - adult |
1,390 |
1,367 |
$63K |
| D2140 |
|
1,357 |
781 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,352 |
2,292 |
$60K |
| D4910 |
|
919 |
884 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,355 |
1,256 |
$43K |
| D4341 |
|
527 |
274 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,986 |
1,937 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,234 |
3,067 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
919 |
909 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,534 |
1,508 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
539 |
532 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,921 |
2,326 |
$18K |
| D1120 |
Prophylaxis - child |
465 |
457 |
$18K |
| D4342 |
|
104 |
65 |
$6K |
| D2160 |
|
82 |
70 |
$6K |
| D2335 |
|
34 |
24 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
30 |
$3K |
| D2331 |
|
33 |
25 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
14 |
$2K |
| D2330 |
|
31 |
24 |
$2K |
| D2931 |
|
17 |
13 |
$2K |
| D2332 |
|
18 |
12 |
$1K |
| D2950 |
|
16 |
12 |
$912.00 |