| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,103 |
2,167 |
$275K |
| D0120 |
Periodic oral evaluation - established patient |
3,718 |
3,685 |
$209K |
| D1110 |
Prophylaxis - adult |
2,358 |
2,346 |
$204K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,371 |
1,035 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,356 |
2,343 |
$149K |
| D1120 |
Prophylaxis - child |
3,467 |
3,446 |
$139K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,214 |
1,438 |
$126K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,277 |
4,602 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,618 |
1,602 |
$77K |
| D4341 |
|
875 |
229 |
$61K |
| D2140 |
|
1,068 |
719 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,513 |
2,499 |
$53K |
| D1351 |
Sealant - per tooth |
1,526 |
379 |
$45K |
| D1206 |
Topical application of fluoride varnish |
3,088 |
3,074 |
$44K |
| D2160 |
|
556 |
383 |
$44K |
| D2330 |
|
348 |
195 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,125 |
2,058 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,316 |
1,309 |
$15K |
| D9430 |
|
476 |
470 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
714 |
701 |
$9K |
| D9993 |
|
24 |
24 |
$1K |
| D1310 |
|
24 |
24 |
$1K |