| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,966 |
6,372 |
$188K |
| D1999 |
|
11,495 |
10,386 |
$169K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,887 |
1,757 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
6,774 |
6,185 |
$96K |
| D0272 |
Bitewings - two radiographic images |
5,511 |
5,017 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,384 |
3,097 |
$71K |
| D0330 |
Panoramic radiographic image |
2,091 |
1,936 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,382 |
3,955 |
$61K |
| D1120 |
Prophylaxis - child |
2,952 |
2,678 |
$55K |
| D2160 |
|
1,022 |
757 |
$51K |
| D2335 |
|
547 |
269 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
269 |
207 |
$23K |
| D2140 |
|
467 |
330 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
740 |
707 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
105 |
$9K |
| D2940 |
|
287 |
242 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
966 |
902 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
12 |
$2K |
| D9996 |
|
12 |
12 |
$154.00 |