| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
16,557 |
3,442 |
$1.07M |
| D0330 |
Panoramic radiographic image |
1,917 |
1,890 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
4,088 |
4,036 |
$105K |
| D1110 |
Prophylaxis - adult |
1,458 |
1,447 |
$61K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
858 |
652 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,789 |
2,775 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,345 |
1,343 |
$34K |
| D1120 |
Prophylaxis - child |
1,331 |
1,329 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,679 |
1,675 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,497 |
3,416 |
$21K |
| D2140 |
|
349 |
259 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,472 |
2,054 |
$15K |
| D0272 |
Bitewings - two radiographic images |
989 |
987 |
$12K |
| D2160 |
|
121 |
98 |
$9K |
| D7310 |
|
85 |
39 |
$8K |
| D2335 |
|
54 |
37 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
69 |
12 |
$7K |
| D2331 |
|
13 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
50 |
47 |
$1K |