| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13,721 |
6,379 |
$910K |
| D0120 |
Periodic oral evaluation - established patient |
16,005 |
15,897 |
$895K |
| D2160 |
|
10,421 |
5,112 |
$817K |
| D7140 |
Extraction, erupted tooth or exposed root |
14,267 |
5,821 |
$808K |
| D1120 |
Prophylaxis - child |
15,901 |
15,838 |
$609K |
| D1110 |
Prophylaxis - adult |
6,250 |
6,223 |
$525K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,810 |
6,780 |
$429K |
| D1351 |
Sealant - per tooth |
15,507 |
4,873 |
$418K |
| D0230 |
Intraoral - periapical each additional radiographic image |
89,060 |
16,616 |
$380K |
| D0210 |
Intraoral - complete series of radiographic images |
6,428 |
6,394 |
$300K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,365 |
1,642 |
$276K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,903 |
15,848 |
$200K |
| D0274 |
Bitewings - four radiographic images |
9,291 |
9,263 |
$193K |
| D2140 |
|
2,905 |
1,895 |
$156K |
| D2161 |
|
1,647 |
1,200 |
$135K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
223 |
183 |
$106K |
| D1206 |
Topical application of fluoride varnish |
6,136 |
6,108 |
$101K |
| D0350 |
|
8,732 |
4,690 |
$85K |
| D1310 |
|
1,782 |
1,773 |
$80K |
| D0272 |
Bitewings - two radiographic images |
5,275 |
5,262 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,598 |
3,537 |
$42K |
| D9430 |
|
1,045 |
1,026 |
$33K |
| D9993 |
|
570 |
568 |
$32K |
| D0601 |
|
1,353 |
1,345 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
263 |
263 |
$15K |
| D2330 |
|
194 |
120 |
$15K |
| D2954 |
|
104 |
89 |
$11K |
| D4341 |
|
50 |
13 |
$4K |
| D4910 |
|
16 |
16 |
$1K |
| D0602 |
|
28 |
28 |
$420.00 |
| D0603 |
|
13 |
13 |
$195.00 |