| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
978 |
629 |
$103K |
| D1206 |
Topical application of fluoride varnish |
1,795 |
1,772 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
460 |
255 |
$52K |
| D2160 |
|
383 |
252 |
$51K |
| D1120 |
Prophylaxis - child |
1,205 |
1,186 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,375 |
1,360 |
$43K |
| D2140 |
|
484 |
337 |
$42K |
| D0274 |
Bitewings - four radiographic images |
828 |
821 |
$32K |
| D1110 |
Prophylaxis - adult |
492 |
491 |
$27K |
| D0330 |
Panoramic radiographic image |
286 |
280 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
323 |
316 |
$18K |
| D0272 |
Bitewings - two radiographic images |
510 |
502 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
296 |
282 |
$6K |
| D1351 |
Sealant - per tooth |
111 |
37 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$962.00 |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$501.00 |