| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,716 |
2,850 |
$220K |
| D1110 |
Prophylaxis - adult |
6,770 |
6,610 |
$211K |
| D0210 |
Intraoral - complete series of radiographic images |
4,229 |
4,054 |
$203K |
| D0274 |
Bitewings - four radiographic images |
7,478 |
7,139 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
8,065 |
7,817 |
$136K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,067 |
8,748 |
$129K |
| D1351 |
Sealant - per tooth |
5,904 |
1,858 |
$107K |
| D1120 |
Prophylaxis - child |
4,316 |
4,182 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,307 |
4,150 |
$96K |
| D4342 |
|
1,665 |
631 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
989 |
483 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,040 |
633 |
$40K |
| D4910 |
|
692 |
683 |
$34K |
| D2140 |
|
1,002 |
640 |
$33K |
| D2160 |
|
605 |
482 |
$32K |
| D4341 |
|
365 |
160 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,206 |
1,129 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,818 |
2,635 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
38 |
$4K |
| D4355 |
|
54 |
53 |
$4K |
| D2330 |
|
68 |
43 |
$3K |
| D0240 |
|
181 |
92 |
$3K |
| D0170 |
|
118 |
115 |
$2K |
| D7111 |
|
39 |
27 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$495.43 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
13 |
$96.91 |