| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,054 |
1,644 |
$192K |
| D1120 |
Prophylaxis - child |
4,581 |
4,411 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
6,689 |
6,480 |
$183K |
| D4341 |
|
1,249 |
600 |
$179K |
| D4342 |
|
1,338 |
728 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,561 |
4,388 |
$117K |
| D0330 |
Panoramic radiographic image |
4,864 |
4,736 |
$117K |
| D1351 |
Sealant - per tooth |
2,053 |
949 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,487 |
3,398 |
$78K |
| D1110 |
Prophylaxis - adult |
1,426 |
1,395 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,414 |
1,364 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
624 |
615 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,397 |
1,342 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
97 |
$7K |
| D2331 |
|
52 |
29 |
$5K |
| D2160 |
|
35 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
221 |
212 |
$2K |
| D2140 |
|
36 |
26 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
298 |
278 |
$1K |
| D9310 |
|
32 |
31 |
$530.10 |