| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,071 |
4,056 |
$218K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,409 |
1,164 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
5,606 |
5,580 |
$153K |
| D2160 |
|
971 |
834 |
$111K |
| D0274 |
Bitewings - four radiographic images |
3,285 |
3,257 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,075 |
740 |
$66K |
| D2140 |
|
814 |
718 |
$57K |
| D1120 |
Prophylaxis - child |
1,304 |
1,302 |
$54K |
| D2330 |
|
592 |
470 |
$38K |
| D0330 |
Panoramic radiographic image |
1,203 |
1,201 |
$37K |
| D1351 |
Sealant - per tooth |
347 |
230 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
1,711 |
1,602 |
$33K |
| D2331 |
|
315 |
268 |
$32K |
| D0240 |
|
1,377 |
984 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,330 |
1,328 |
$18K |
| D2951 |
|
545 |
501 |
$18K |
| D2335 |
|
148 |
126 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,640 |
1,591 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
215 |
176 |
$14K |
| D0272 |
Bitewings - two radiographic images |
717 |
716 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
797 |
751 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
63 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
393 |
379 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
138 |
138 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
27 |
$2K |
| D2332 |
|
12 |
12 |
$2K |
| D7510 |
|
17 |
14 |
$790.00 |
| D9110 |
|
36 |
32 |
$713.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
411 |
400 |
$350.00 |