| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,867 |
5,263 |
$281K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,452 |
1,288 |
$276K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,172 |
1,248 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
8,175 |
7,068 |
$215K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,959 |
8,837 |
$196K |
| D2140 |
|
2,836 |
1,087 |
$184K |
| D0210 |
Intraoral - complete series of radiographic images |
1,721 |
1,540 |
$147K |
| D0272 |
Bitewings - two radiographic images |
6,008 |
5,425 |
$146K |
| D1120 |
Prophylaxis - child |
4,089 |
3,569 |
$146K |
| D1351 |
Sealant - per tooth |
4,432 |
1,426 |
$124K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
629 |
240 |
$88K |
| D2160 |
|
840 |
441 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,911 |
1,870 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,998 |
1,764 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,416 |
1,237 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
1,940 |
1,695 |
$34K |
| D0603 |
|
5,816 |
5,335 |
$29K |
| D0330 |
Panoramic radiographic image |
163 |
134 |
$10K |
| D2330 |
|
88 |
45 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
363 |
267 |
$5K |
| D0602 |
|
893 |
782 |
$4K |
| D2332 |
|
23 |
13 |
$3K |
| D7111 |
|
23 |
12 |
$1K |
| D0601 |
|
22 |
15 |
$105.00 |