| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2160 |
|
4,242 |
2,287 |
$335K |
| D0120 |
Periodic oral evaluation - established patient |
3,722 |
3,715 |
$219K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,778 |
1,582 |
$185K |
| D1120 |
Prophylaxis - child |
3,719 |
3,702 |
$141K |
| D1110 |
Prophylaxis - adult |
1,508 |
1,503 |
$124K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
252 |
203 |
$120K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,020 |
2,269 |
$119K |
| D4910 |
|
1,497 |
1,496 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,263 |
4,781 |
$106K |
| D1351 |
Sealant - per tooth |
3,544 |
972 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,395 |
1,393 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,262 |
688 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,423 |
3,410 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,215 |
5,199 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
828 |
449 |
$55K |
| D3221 |
|
419 |
325 |
$26K |
| D9430 |
|
763 |
760 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
177 |
129 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,743 |
1,724 |
$21K |
| D2954 |
|
184 |
148 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
356 |
241 |
$19K |
| D4341 |
|
271 |
75 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
294 |
294 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
71 |
$10K |
| D2161 |
|
75 |
62 |
$6K |
| D0272 |
Bitewings - two radiographic images |
271 |
271 |
$3K |
| D4342 |
|
47 |
16 |
$2K |