| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,954 |
1,203 |
$137K |
| D1110 |
Prophylaxis - adult |
2,798 |
2,792 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,534 |
3,528 |
$122K |
| D0274 |
Bitewings - four radiographic images |
4,154 |
4,145 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,158 |
1,181 |
$114K |
| D1120 |
Prophylaxis - child |
2,792 |
2,787 |
$87K |
| D2140 |
|
1,236 |
683 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,191 |
3,185 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,159 |
2,157 |
$47K |
| D9110 |
|
809 |
804 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
616 |
479 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
633 |
369 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
355 |
240 |
$38K |
| D2160 |
|
326 |
238 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,900 |
1,841 |
$21K |
| D2331 |
|
163 |
128 |
$13K |
| D2330 |
|
183 |
119 |
$12K |
| D0272 |
Bitewings - two radiographic images |
433 |
431 |
$9K |
| D2335 |
|
56 |
38 |
$7K |
| D0330 |
Panoramic radiographic image |
102 |
102 |
$5K |
| D2332 |
|
16 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
43 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
70 |
56 |
$642.50 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$354.83 |