| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,960 |
2,250 |
$391K |
| D0120 |
Periodic oral evaluation - established patient |
7,503 |
7,448 |
$389K |
| D1110 |
Prophylaxis - adult |
3,991 |
3,969 |
$338K |
| D1120 |
Prophylaxis - child |
5,769 |
5,728 |
$224K |
| D1351 |
Sealant - per tooth |
8,205 |
1,465 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,444 |
3,426 |
$201K |
| D0210 |
Intraoral - complete series of radiographic images |
2,976 |
2,962 |
$137K |
| D9430 |
|
3,675 |
3,576 |
$116K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
930 |
509 |
$105K |
| D0330 |
Panoramic radiographic image |
3,293 |
3,274 |
$95K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,594 |
762 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,197 |
8,914 |
$74K |
| D0274 |
Bitewings - four radiographic images |
4,432 |
4,395 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
6,037 |
5,476 |
$71K |
| D4341 |
|
690 |
203 |
$48K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
16 |
$10K |
| D2140 |
|
128 |
82 |
$7K |
| D2331 |
|
51 |
24 |
$4K |
| D2330 |
|
45 |
26 |
$3K |
| D1320 |
|
32 |
32 |
$452.50 |