| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,213 |
1,047 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,819 |
1,806 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
1,196 |
1,192 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,135 |
1,124 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
398 |
143 |
$44K |
| D0350 |
|
4,722 |
1,234 |
$41K |
| D2140 |
|
697 |
369 |
$37K |
| D2160 |
|
383 |
229 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,530 |
1,804 |
$18K |
| D1120 |
Prophylaxis - child |
580 |
579 |
$17K |
| D0272 |
Bitewings - two radiographic images |
762 |
762 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
477 |
474 |
$4K |
| D4341 |
|
49 |
13 |
$4K |
| D0274 |
Bitewings - four radiographic images |
134 |
132 |
$2K |
| D9430 |
|
85 |
83 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
131 |
128 |
$1K |
| D0330 |
Panoramic radiographic image |
47 |
47 |
$1K |
| D1110 |
Prophylaxis - adult |
17 |
16 |
$560.00 |