| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,368 |
649 |
$91K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
178 |
151 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,018 |
1,014 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
739 |
729 |
$58K |
| D1110 |
Prophylaxis - adult |
611 |
608 |
$54K |
| D1120 |
Prophylaxis - child |
880 |
865 |
$43K |
| D2140 |
|
734 |
302 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,050 |
1,937 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
576 |
285 |
$31K |
| D9430 |
|
619 |
568 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,162 |
1,153 |
$17K |
| D0274 |
Bitewings - four radiographic images |
698 |
698 |
$15K |
| D2952 |
|
136 |
116 |
$13K |
| D2160 |
|
110 |
69 |
$9K |
| D0272 |
Bitewings - two radiographic images |
681 |
664 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
24 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
484 |
464 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
90 |
90 |
$4K |
| D0350 |
|
278 |
102 |
$2K |
| D1206 |
Topical application of fluoride varnish |
143 |
143 |
$2K |
| D1351 |
Sealant - per tooth |
93 |
24 |
$2K |
| D4910 |
|
15 |
15 |
$1K |