| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,711 |
4,297 |
$213K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,261 |
1,377 |
$171K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
740 |
275 |
$128K |
| D0274 |
Bitewings - four radiographic images |
3,394 |
3,108 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
4,244 |
3,809 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,257 |
428 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
1,938 |
1,810 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,956 |
1,600 |
$67K |
| D2160 |
|
552 |
402 |
$55K |
| D1351 |
Sealant - per tooth |
1,814 |
367 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,341 |
1,270 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,329 |
2,054 |
$43K |
| D2140 |
|
626 |
469 |
$37K |
| D0330 |
Panoramic radiographic image |
1,106 |
983 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,213 |
2,923 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
475 |
306 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,147 |
1,204 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
675 |
574 |
$19K |
| D1120 |
Prophylaxis - child |
712 |
630 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
118 |
90 |
$10K |
| D2335 |
|
59 |
40 |
$8K |
| D2332 |
|
17 |
12 |
$2K |
| D2331 |
|
19 |
16 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
60 |
51 |
$825.35 |
| D1999 |
|
741 |
471 |
$0.00 |