| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,177 |
4,129 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
6,068 |
5,997 |
$158K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,555 |
1,030 |
$122K |
| D0272 |
Bitewings - two radiographic images |
5,169 |
5,113 |
$114K |
| D1206 |
Topical application of fluoride varnish |
5,237 |
5,183 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,403 |
4,410 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
1,212 |
1,199 |
$95K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
806 |
239 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
5,104 |
5,029 |
$90K |
| D2160 |
|
907 |
614 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,193 |
291 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,668 |
2,398 |
$67K |
| D1120 |
Prophylaxis - child |
1,853 |
1,833 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
740 |
504 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
947 |
896 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
182 |
122 |
$15K |
| D0603 |
|
2,748 |
2,724 |
$14K |
| D1351 |
Sealant - per tooth |
364 |
116 |
$10K |
| D2332 |
|
82 |
52 |
$9K |
| D0602 |
|
1,531 |
1,513 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
336 |
333 |
$7K |
| D0330 |
Panoramic radiographic image |
448 |
441 |
$6K |
| D2140 |
|
53 |
42 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$852.15 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$296.40 |