| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
641 |
305 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
841 |
$41K |
| D9430 |
|
1,186 |
1,075 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
244 |
82 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
569 |
567 |
$25K |
| D2140 |
|
459 |
192 |
$25K |
| D1110 |
Prophylaxis - adult |
267 |
267 |
$16K |
| D1120 |
Prophylaxis - child |
445 |
443 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
274 |
270 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,496 |
1,049 |
$9K |
| D2330 |
|
105 |
48 |
$8K |
| D2160 |
|
100 |
54 |
$8K |
| D0274 |
Bitewings - four radiographic images |
227 |
227 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
435 |
433 |
$4K |
| D0350 |
|
370 |
143 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
25 |
$3K |
| D2332 |
|
27 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
60 |
60 |
$1K |
| D0272 |
Bitewings - two radiographic images |
95 |
95 |
$990.00 |
| D0270 |
|
87 |
87 |
$430.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$140.00 |