| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,002 |
1,528 |
$201K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,449 |
849 |
$170K |
| D1110 |
Prophylaxis - adult |
1,964 |
1,960 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,214 |
2,199 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
2,140 |
2,127 |
$111K |
| D1120 |
Prophylaxis - child |
1,763 |
1,758 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,725 |
3,802 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,429 |
2,422 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,667 |
3,659 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
902 |
898 |
$42K |
| D2140 |
|
713 |
438 |
$39K |
| D9110 |
|
317 |
265 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,488 |
1,461 |
$18K |
| D0350 |
|
1,864 |
1,128 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
33 |
27 |
$16K |
| D9430 |
|
253 |
252 |
$8K |
| D4341 |
|
53 |
15 |
$4K |
| D2160 |
|
38 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
242 |
242 |
$3K |
| D1351 |
Sealant - per tooth |
113 |
38 |
$2K |
| D2954 |
|
16 |
14 |
$2K |