| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,924 |
1,912 |
$95K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
952 |
553 |
$63K |
| D1120 |
Prophylaxis - child |
1,581 |
1,574 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
492 |
268 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
871 |
869 |
$51K |
| D1110 |
Prophylaxis - adult |
613 |
604 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,071 |
2,206 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
922 |
914 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
487 |
258 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,152 |
1,146 |
$23K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
38 |
29 |
$18K |
| D9430 |
|
558 |
546 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,312 |
1,252 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,505 |
1,498 |
$15K |
| D2160 |
|
172 |
121 |
$14K |
| D0350 |
|
707 |
461 |
$7K |
| D2954 |
|
20 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
136 |
134 |
$1K |
| D2140 |
|
17 |
12 |
$928.20 |
| D0270 |
|
41 |
40 |
$205.00 |