| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,579 |
1,837 |
$286K |
| D1110 |
Prophylaxis - adult |
5,738 |
5,431 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
7,840 |
7,409 |
$181K |
| D0274 |
Bitewings - four radiographic images |
3,903 |
3,684 |
$138K |
| D2160 |
|
1,319 |
791 |
$133K |
| D1206 |
Topical application of fluoride varnish |
5,175 |
4,922 |
$114K |
| D1351 |
Sealant - per tooth |
4,122 |
1,028 |
$110K |
| D1120 |
Prophylaxis - child |
3,092 |
2,949 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,241 |
644 |
$93K |
| D2140 |
|
874 |
540 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
652 |
386 |
$50K |
| D2330 |
|
585 |
354 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,191 |
1,151 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
520 |
314 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,170 |
1,116 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
87 |
37 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
389 |
368 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
363 |
340 |
$5K |
| D2331 |
|
44 |
36 |
$4K |
| D2332 |
|
26 |
14 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
55 |
$3K |
| D0330 |
Panoramic radiographic image |
39 |
38 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
26 |
$990.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
13 |
$160.00 |