| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,974 |
1,959 |
$112K |
| D2140 |
|
1,865 |
620 |
$93K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
801 |
430 |
$86K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
954 |
420 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
1,608 |
1,597 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
864 |
283 |
$45K |
| D1120 |
Prophylaxis - child |
1,420 |
1,400 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,004 |
1,484 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,928 |
1,893 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
834 |
819 |
$18K |
| D1110 |
Prophylaxis - adult |
182 |
177 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,199 |
1,187 |
$13K |
| D0330 |
Panoramic radiographic image |
899 |
893 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
145 |
66 |
$8K |
| D9430 |
|
235 |
228 |
$7K |
| D2331 |
|
24 |
14 |
$2K |
| D2330 |
|
23 |
14 |
$2K |
| D2160 |
|
14 |
12 |
$963.30 |
| D0272 |
Bitewings - two radiographic images |
79 |
78 |
$777.33 |