| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
866 |
419 |
$63K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,095 |
632 |
$62K |
| D2140 |
|
914 |
533 |
$43K |
| D1110 |
Prophylaxis - adult |
838 |
827 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,031 |
1,014 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,336 |
1,315 |
$34K |
| D1120 |
Prophylaxis - child |
688 |
677 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
560 |
551 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
796 |
731 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,182 |
1,163 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,258 |
1,240 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,022 |
1,920 |
$21K |
| D2160 |
|
244 |
184 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,636 |
1,459 |
$11K |
| D4342 |
|
194 |
121 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
111 |
69 |
$9K |
| D4910 |
|
138 |
137 |
$9K |
| D1351 |
Sealant - per tooth |
412 |
115 |
$9K |
| D2335 |
|
79 |
52 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
24 |
$4K |
| D2330 |
|
45 |
25 |
$3K |
| D2161 |
|
19 |
12 |
$2K |
| D2931 |
|
15 |
12 |
$1K |