| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,142 |
1,750 |
$169K |
| D1110 |
Prophylaxis - adult |
1,508 |
1,421 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
2,134 |
1,871 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,833 |
2,493 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,668 |
2,498 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,526 |
1,492 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,124 |
1,000 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,607 |
3,270 |
$33K |
| D2160 |
|
469 |
356 |
$31K |
| D2140 |
|
574 |
407 |
$22K |
| D0274 |
Bitewings - four radiographic images |
816 |
723 |
$14K |
| D2332 |
|
206 |
132 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
123 |
71 |
$7K |
| D1120 |
Prophylaxis - child |
182 |
166 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
65 |
36 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
91 |
$5K |
| D0272 |
Bitewings - two radiographic images |
296 |
281 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
85 |
$3K |
| D4910 |
|
25 |
25 |
$1K |
| D2335 |
|
13 |
12 |
$1K |
| D2331 |
|
18 |
12 |
$1K |
| D1999 |
|
123 |
88 |
$735.00 |
| D0180 |
|
12 |
12 |
$252.00 |
| D0330 |
Panoramic radiographic image |
128 |
128 |
$104.00 |
| D1330 |
|
37 |
37 |
$10.00 |
| D1310 |
|
37 |
37 |
$0.00 |