| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,144 |
3,122 |
$266K |
| D0120 |
Periodic oral evaluation - established patient |
4,007 |
3,982 |
$228K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,504 |
1,364 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,196 |
5,849 |
$131K |
| D2160 |
|
1,541 |
938 |
$122K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
971 |
423 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,840 |
1,818 |
$115K |
| D2740 |
Crown - porcelain/ceramic |
233 |
190 |
$111K |
| D0274 |
Bitewings - four radiographic images |
4,867 |
4,835 |
$103K |
| D1120 |
Prophylaxis - child |
2,193 |
2,182 |
$79K |
| D2140 |
|
423 |
246 |
$23K |
| D2330 |
|
276 |
124 |
$21K |
| D0350 |
|
1,065 |
863 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,611 |
1,602 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,068 |
1,028 |
$13K |
| D1351 |
Sealant - per tooth |
444 |
137 |
$10K |
| D4341 |
|
134 |
45 |
$8K |
| D9430 |
|
104 |
95 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
15 |
$2K |
| D2931 |
|
14 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
70 |
70 |
$782.00 |
| D1999 |
|
101 |
94 |
$92.00 |