| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
810 |
797 |
$14K |
| D1110 |
Prophylaxis - adult |
446 |
437 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
193 |
90 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
650 |
641 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
424 |
413 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
79 |
$8K |
| D5214 |
|
12 |
12 |
$6K |
| D2160 |
|
78 |
49 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
39 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
44 |
$4K |
| D0330 |
Panoramic radiographic image |
127 |
121 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
54 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
92 |
92 |
$1K |
| D1120 |
Prophylaxis - child |
72 |
71 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
287 |
281 |
$1K |
| D0272 |
Bitewings - two radiographic images |
31 |
31 |
$310.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
64 |
$287.00 |