| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,999 |
11,982 |
$506K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,585 |
3,332 |
$337K |
| D0120 |
Periodic oral evaluation - established patient |
12,825 |
12,806 |
$279K |
| D0274 |
Bitewings - four radiographic images |
12,072 |
12,053 |
$235K |
| D2752 |
|
350 |
301 |
$134K |
| D2140 |
|
3,220 |
1,824 |
$132K |
| D0330 |
Panoramic radiographic image |
4,004 |
3,997 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
12,392 |
12,306 |
$113K |
| D2160 |
|
1,195 |
962 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,595 |
12,557 |
$84K |
| D1120 |
Prophylaxis - child |
2,180 |
2,179 |
$72K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
204 |
191 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,328 |
2,327 |
$55K |
| D2161 |
|
517 |
348 |
$47K |
| D9110 |
|
1,661 |
1,648 |
$35K |
| D1351 |
Sealant - per tooth |
1,000 |
260 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,702 |
2,702 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
335 |
238 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,741 |
1,737 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,249 |
1,245 |
$17K |
| D2952 |
|
172 |
144 |
$16K |
| D2332 |
|
188 |
112 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
511 |
511 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
121 |
$7K |
| D2335 |
|
64 |
49 |
$6K |
| D2920 |
|
205 |
159 |
$6K |
| D2954 |
|
43 |
37 |
$5K |
| D0270 |
|
380 |
378 |
$4K |
| D4341 |
|
44 |
13 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
16 |
$1K |
| D2331 |
|
18 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
18 |
$542.74 |
| D9920 |
|
16 |
15 |
$371.20 |