| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,499 |
686 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
1,553 |
1,548 |
$59K |
| D1120 |
Prophylaxis - child |
1,784 |
1,780 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
726 |
724 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,192 |
2,152 |
$40K |
| D2160 |
|
272 |
173 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,074 |
2,068 |
$20K |
| D0274 |
Bitewings - four radiographic images |
728 |
725 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
196 |
105 |
$11K |
| D0350 |
|
1,196 |
609 |
$11K |
| D0272 |
Bitewings - two radiographic images |
822 |
820 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
192 |
192 |
$9K |
| D2140 |
|
132 |
82 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
535 |
528 |
$6K |
| D1110 |
Prophylaxis - adult |
29 |
29 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
66 |
16 |
$1K |
| D9110 |
|
15 |
13 |
$945.00 |
| D9430 |
|
28 |
27 |
$856.00 |