| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,699 |
1,781 |
$247K |
| D1110 |
Prophylaxis - adult |
4,479 |
4,417 |
$166K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,585 |
702 |
$165K |
| D2160 |
|
1,351 |
1,026 |
$143K |
| D2140 |
|
1,939 |
1,268 |
$141K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,170 |
4,450 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,901 |
2,855 |
$123K |
| D0330 |
Panoramic radiographic image |
2,868 |
2,821 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
2,878 |
2,699 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
6,331 |
5,995 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,329 |
947 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,551 |
3,487 |
$83K |
| D0274 |
Bitewings - four radiographic images |
3,442 |
3,380 |
$83K |
| D4355 |
|
1,187 |
1,171 |
$79K |
| D7311 |
|
439 |
316 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,670 |
1,646 |
$27K |
| D2332 |
|
272 |
188 |
$26K |
| D1120 |
Prophylaxis - child |
503 |
498 |
$14K |
| D4341 |
|
133 |
62 |
$13K |
| D2331 |
|
109 |
82 |
$9K |
| D2330 |
|
99 |
63 |
$6K |
| D2335 |
|
15 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
35 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
27 |
26 |
$474.10 |
| D0170 |
|
13 |
12 |
$312.60 |