| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,582 |
3,151 |
$143K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,945 |
1,120 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
3,513 |
3,056 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,495 |
2,177 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,017 |
862 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
297 |
136 |
$45K |
| D1351 |
Sealant - per tooth |
2,168 |
421 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,459 |
2,135 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,047 |
892 |
$33K |
| D2160 |
|
284 |
201 |
$27K |
| D0330 |
Panoramic radiographic image |
1,122 |
958 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,008 |
901 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
361 |
135 |
$21K |
| D1120 |
Prophylaxis - child |
953 |
819 |
$19K |
| D2140 |
|
408 |
316 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,025 |
1,686 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
595 |
489 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
270 |
163 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,784 |
587 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
15 |
$0.00 |