| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,815 |
9,778 |
$263K |
| D0120 |
Periodic oral evaluation - established patient |
12,403 |
12,353 |
$191K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,792 |
2,377 |
$111K |
| D2140 |
|
3,777 |
2,877 |
$101K |
| D1351 |
Sealant - per tooth |
2,493 |
898 |
$95K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,153 |
905 |
$66K |
| D1120 |
Prophylaxis - child |
2,229 |
2,219 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,506 |
1,166 |
$50K |
| D2160 |
|
1,038 |
935 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,110 |
4,099 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
769 |
764 |
$20K |
| D2161 |
|
304 |
278 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,713 |
1,712 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
872 |
862 |
$5K |
| D2335 |
|
67 |
60 |
$4K |
| D5760 |
|
41 |
41 |
$2K |
| D5650 |
|
54 |
42 |
$2K |
| D5761 |
|
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
33 |
33 |
$538.66 |
| D9110 |
|
37 |
37 |
$366.62 |
| D1999 |
|
59 |
58 |
$0.00 |