| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,638 |
860 |
$75K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
964 |
625 |
$51K |
| D1120 |
Prophylaxis - child |
1,246 |
1,190 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,613 |
1,549 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,114 |
1,066 |
$27K |
| D2160 |
|
375 |
259 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
752 |
685 |
$14K |
| D0274 |
Bitewings - four radiographic images |
683 |
654 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
405 |
317 |
$10K |
| D4341 |
|
62 |
27 |
$10K |
| D1110 |
Prophylaxis - adult |
307 |
287 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
367 |
336 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
498 |
465 |
$7K |
| D2140 |
|
207 |
161 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
59 |
46 |
$4K |
| D0272 |
Bitewings - two radiographic images |
390 |
375 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
451 |
428 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
292 |
252 |
$2K |
| D2161 |
|
18 |
15 |
$1K |