| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,198 |
6,133 |
$348K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,957 |
1,684 |
$285K |
| D0120 |
Periodic oral evaluation - established patient |
8,204 |
8,130 |
$256K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,590 |
1,228 |
$236K |
| D2140 |
|
2,631 |
1,538 |
$205K |
| D0210 |
Intraoral - complete series of radiographic images |
1,664 |
1,645 |
$171K |
| D1206 |
Topical application of fluoride varnish |
6,600 |
6,526 |
$169K |
| D1120 |
Prophylaxis - child |
3,883 |
3,859 |
$159K |
| D0274 |
Bitewings - four radiographic images |
3,140 |
3,118 |
$119K |
| D2160 |
|
1,005 |
551 |
$109K |
| D2931 |
|
510 |
292 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,031 |
2,015 |
$99K |
| D2331 |
|
530 |
270 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,350 |
3,290 |
$59K |
| D2330 |
|
624 |
342 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,610 |
2,259 |
$48K |
| D9920 |
|
323 |
315 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
652 |
649 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,249 |
1,947 |
$25K |
| D0272 |
Bitewings - two radiographic images |
725 |
715 |
$21K |
| D9420 |
|
103 |
102 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
831 |
831 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
55 |
28 |
$11K |
| D1351 |
Sealant - per tooth |
33 |
12 |
$1K |