| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,045 |
2,037 |
$175K |
| D0120 |
Periodic oral evaluation - established patient |
2,920 |
2,913 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,205 |
2,196 |
$141K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,012 |
1,079 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
2,179 |
2,171 |
$100K |
| D1120 |
Prophylaxis - child |
2,464 |
2,455 |
$93K |
| D9430 |
|
2,219 |
2,093 |
$70K |
| D4910 |
|
533 |
530 |
$41K |
| D1351 |
Sealant - per tooth |
1,500 |
413 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,614 |
3,981 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,950 |
2,941 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,564 |
1,556 |
$33K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
63 |
43 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,725 |
1,715 |
$30K |
| D2140 |
|
392 |
236 |
$21K |
| D4341 |
|
290 |
88 |
$20K |
| D1320 |
|
1,329 |
1,312 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,616 |
1,569 |
$19K |
| D2160 |
|
146 |
96 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
91 |
70 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
83 |
$7K |
| D3221 |
|
97 |
82 |
$6K |
| D0272 |
Bitewings - two radiographic images |
447 |
447 |
$5K |
| D0350 |
|
344 |
192 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$560.00 |
| D9920 |
|
17 |
16 |
$280.00 |