| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
927 |
290 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
759 |
754 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
745 |
737 |
$32K |
| D2140 |
|
576 |
210 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
641 |
636 |
$28K |
| D1120 |
Prophylaxis - child |
873 |
865 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,606 |
1,064 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
297 |
117 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
865 |
857 |
$8K |
| D0274 |
Bitewings - four radiographic images |
298 |
297 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
44 |
$6K |
| D1351 |
Sealant - per tooth |
231 |
77 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
365 |
350 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
33 |
$4K |
| D0350 |
|
340 |
95 |
$3K |
| D1110 |
Prophylaxis - adult |
26 |
26 |
$2K |
| D9430 |
|
28 |
28 |
$843.00 |
| D0272 |
Bitewings - two radiographic images |
44 |
44 |
$482.00 |