| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,524 |
1,814 |
$174K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,287 |
1,442 |
$158K |
| D1110 |
Prophylaxis - adult |
3,718 |
3,704 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
4,564 |
4,541 |
$109K |
| D1120 |
Prophylaxis - child |
2,093 |
2,088 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,278 |
1,271 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
2,351 |
2,292 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,344 |
2,335 |
$67K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
140 |
103 |
$65K |
| D2160 |
|
813 |
649 |
$60K |
| D2140 |
|
1,242 |
941 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,688 |
1,681 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,211 |
2,202 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,281 |
4,102 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
329 |
239 |
$27K |
| D2740 |
Crown - porcelain/ceramic |
33 |
28 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
163 |
109 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,095 |
1,530 |
$14K |
| D1354 |
|
377 |
136 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
30 |
$7K |
| D2950 |
|
17 |
16 |
$3K |
| D0272 |
Bitewings - two radiographic images |
49 |
49 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
12 |
12 |
$922.15 |
| D1999 |
|
2,861 |
2,611 |
$0.00 |
| D9995 |
|
13 |
13 |
$0.00 |