| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,824 |
620 |
$273K |
| D1110 |
Prophylaxis - adult |
2,617 |
2,330 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
4,205 |
3,699 |
$109K |
| D2160 |
|
971 |
440 |
$90K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,033 |
503 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,542 |
3,132 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
734 |
642 |
$62K |
| D0272 |
Bitewings - two radiographic images |
2,378 |
2,055 |
$56K |
| D1120 |
Prophylaxis - child |
1,001 |
879 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,314 |
817 |
$34K |
| D9920 |
|
1,403 |
1,389 |
$27K |
| D0330 |
Panoramic radiographic image |
473 |
413 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,366 |
1,120 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
685 |
591 |
$23K |
| D1351 |
Sealant - per tooth |
691 |
170 |
$19K |
| D5110 |
|
82 |
29 |
$18K |
| D5120 |
|
46 |
15 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
903 |
729 |
$13K |
| D0602 |
|
1,452 |
1,279 |
$7K |
| D0274 |
Bitewings - four radiographic images |
313 |
312 |
$7K |
| D0601 |
|
856 |
765 |
$4K |
| D2161 |
|
32 |
24 |
$4K |
| D1320 |
|
126 |
105 |
$3K |
| D0603 |
|
490 |
431 |
$2K |
| D2140 |
|
23 |
12 |
$2K |