| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,138 |
8,111 |
$523K |
| D0140 |
Limited oral evaluation - problem focused |
5,688 |
5,493 |
$466K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,105 |
2,442 |
$456K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,186 |
3,308 |
$423K |
| D0120 |
Periodic oral evaluation - established patient |
7,419 |
7,388 |
$341K |
| D2140 |
|
2,822 |
2,352 |
$259K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,517 |
2,506 |
$175K |
| D2331 |
|
1,459 |
1,092 |
$155K |
| D2330 |
|
1,327 |
982 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
2,950 |
2,930 |
$122K |
| D2160 |
|
1,048 |
946 |
$115K |
| D1120 |
Prophylaxis - child |
2,777 |
2,766 |
$109K |
| D1206 |
Topical application of fluoride varnish |
3,685 |
3,668 |
$91K |
| D1351 |
Sealant - per tooth |
2,180 |
356 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,944 |
2,937 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
5,701 |
5,555 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
339 |
261 |
$38K |
| D5110 |
|
43 |
43 |
$38K |
| D4355 |
|
157 |
157 |
$17K |
| D5120 |
|
13 |
13 |
$12K |
| D5214 |
|
13 |
13 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,378 |
1,760 |
$11K |
| D0272 |
Bitewings - two radiographic images |
453 |
451 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
54 |
$6K |
| D2332 |
|
14 |
13 |
$1K |
| D0191 |
|
63 |
61 |
$837.00 |