| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
989 |
587 |
$57K |
| D1120 |
Prophylaxis - child |
1,372 |
1,296 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,008 |
589 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,533 |
1,436 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,066 |
984 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,201 |
1,120 |
$18K |
| D1206 |
Topical application of fluoride varnish |
734 |
672 |
$18K |
| D1110 |
Prophylaxis - adult |
470 |
412 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,481 |
2,494 |
$17K |
| D1351 |
Sealant - per tooth |
163 |
115 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,212 |
2,925 |
$17K |
| D2140 |
|
459 |
264 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
229 |
107 |
$13K |
| D2160 |
|
160 |
127 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
634 |
601 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
33 |
27 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
386 |
377 |
$9K |
| D2950 |
|
74 |
55 |
$5K |
| D5110 |
|
12 |
12 |
$5K |
| D0272 |
Bitewings - two radiographic images |
421 |
387 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
204 |
181 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
42 |
$3K |
| D2331 |
|
61 |
39 |
$3K |
| D0330 |
Panoramic radiographic image |
165 |
157 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
29 |
$2K |
| D0270 |
|
15 |
13 |
$56.00 |