| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,600 |
2,587 |
$212K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,591 |
2,583 |
$156K |
| D4341 |
|
2,079 |
619 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
2,969 |
2,965 |
$123K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,370 |
776 |
$91K |
| D1120 |
Prophylaxis - child |
2,713 |
2,702 |
$81K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
610 |
382 |
$71K |
| D2140 |
|
1,270 |
545 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,155 |
504 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,072 |
559 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
1,347 |
1,341 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,063 |
4,303 |
$52K |
| D1351 |
Sealant - per tooth |
2,441 |
558 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,800 |
1,795 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
477 |
258 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,545 |
1,539 |
$18K |
| D4342 |
|
281 |
111 |
$12K |
| D2160 |
|
140 |
96 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
927 |
913 |
$11K |
| D2331 |
|
134 |
68 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,666 |
2,659 |
$9K |
| D2330 |
|
88 |
51 |
$7K |
| D5212 |
|
12 |
12 |
$4K |
| D2332 |
|
40 |
28 |
$4K |
| D3221 |
|
35 |
26 |
$2K |
| D9430 |
|
38 |
38 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |