| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,029 |
1,816 |
$285K |
| D1110 |
Prophylaxis - adult |
5,473 |
5,394 |
$259K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,670 |
1,075 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
7,520 |
7,392 |
$196K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,972 |
8,833 |
$176K |
| D0210 |
Intraoral - complete series of radiographic images |
2,164 |
2,072 |
$176K |
| D1351 |
Sealant - per tooth |
6,017 |
1,799 |
$163K |
| D0272 |
Bitewings - two radiographic images |
6,291 |
6,201 |
$144K |
| D1120 |
Prophylaxis - child |
3,472 |
3,420 |
$122K |
| D0140 |
Limited oral evaluation - problem focused |
3,013 |
2,932 |
$99K |
| D2160 |
|
987 |
456 |
$91K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
604 |
193 |
$84K |
| D2140 |
|
970 |
470 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,541 |
1,530 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
2,751 |
2,657 |
$49K |
| D0330 |
Panoramic radiographic image |
1,011 |
1,002 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,674 |
1,574 |
$42K |
| D0603 |
|
6,049 |
5,950 |
$29K |
| D2332 |
|
82 |
51 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
632 |
552 |
$9K |
| D2161 |
|
16 |
12 |
$2K |
| D0602 |
|
142 |
141 |
$685.00 |