| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,311 |
1,519 |
$96K |
| D1110 |
Prophylaxis - adult |
3,363 |
3,058 |
$90K |
| D1999 |
|
3,921 |
3,188 |
$60K |
| D0330 |
Panoramic radiographic image |
2,010 |
1,835 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,702 |
2,494 |
$58K |
| D0272 |
Bitewings - two radiographic images |
3,091 |
2,839 |
$45K |
| D2140 |
|
1,340 |
930 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,086 |
1,871 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,112 |
1,937 |
$30K |
| D1120 |
Prophylaxis - child |
1,346 |
1,236 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,401 |
1,247 |
$11K |
| D2160 |
|
178 |
150 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
66 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
178 |
99 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
30 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
69 |
$893.20 |
| D2332 |
|
15 |
12 |
$576.32 |
| D2331 |
|
17 |
14 |
$540.50 |