| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,842 |
1,731 |
$252K |
| D2160 |
|
1,857 |
1,077 |
$144K |
| D1110 |
Prophylaxis - adult |
1,363 |
1,361 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,574 |
1,567 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
1,793 |
1,791 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,699 |
1,692 |
$77K |
| D2140 |
|
946 |
544 |
$50K |
| D1120 |
Prophylaxis - child |
1,321 |
1,310 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,111 |
2,567 |
$41K |
| D9430 |
|
1,214 |
1,174 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,746 |
2,730 |
$31K |
| D4341 |
|
447 |
132 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,179 |
1,171 |
$22K |
| D0350 |
|
1,996 |
900 |
$20K |
| D1351 |
Sealant - per tooth |
554 |
174 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
231 |
118 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,215 |
1,174 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
74 |
54 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
50 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
45 |
$4K |
| D4910 |
|
54 |
54 |
$4K |
| D2954 |
|
15 |
13 |
$2K |
| D2161 |
|
14 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
59 |
59 |
$656.00 |