| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,272 |
749 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,986 |
1,971 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,201 |
1,199 |
$71K |
| D2160 |
|
725 |
470 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
668 |
667 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
267 |
167 |
$30K |
| D1120 |
Prophylaxis - child |
957 |
945 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
414 |
255 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,943 |
1,934 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,517 |
2,205 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,024 |
1,015 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
542 |
529 |
$6K |
| D2140 |
|
75 |
56 |
$4K |
| D9430 |
|
62 |
62 |
$2K |
| D0350 |
|
133 |
61 |
$1K |