| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
20,541 |
20,504 |
$601K |
| D1120 |
Prophylaxis - child |
16,025 |
15,993 |
$506K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,171 |
3,104 |
$444K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,051 |
23,997 |
$432K |
| D1110 |
Prophylaxis - adult |
7,838 |
7,815 |
$354K |
| D0220 |
Intraoral - periapical first radiographic image |
29,465 |
29,212 |
$333K |
| D0120 |
Periodic oral evaluation - established patient |
15,156 |
15,133 |
$308K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,680 |
26,829 |
$297K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,363 |
8,324 |
$288K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,374 |
1,699 |
$242K |
| D1351 |
Sealant - per tooth |
9,033 |
2,510 |
$216K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,648 |
871 |
$182K |
| D2140 |
|
3,291 |
1,790 |
$178K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,484 |
1,268 |
$164K |
| D0210 |
Intraoral - complete series of radiographic images |
2,421 |
2,320 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,292 |
1,098 |
$120K |
| D2160 |
|
1,193 |
732 |
$103K |
| D4341 |
|
744 |
295 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
2,044 |
2,027 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,274 |
2,274 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
418 |
288 |
$37K |
| D2161 |
|
216 |
143 |
$23K |
| D2332 |
|
44 |
25 |
$5K |
| D2331 |
|
36 |
25 |
$3K |
| D2330 |
|
19 |
12 |
$1K |
| D9110 |
|
16 |
16 |
$897.95 |
| D1206 |
Topical application of fluoride varnish |
20 |
20 |
$369.12 |
| D0270 |
|
31 |
31 |
$323.25 |