| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
10,462 |
9,725 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,515 |
9,510 |
$149K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,753 |
2,304 |
$145K |
| D1120 |
Prophylaxis - child |
7,072 |
6,379 |
$133K |
| D2140 |
|
4,163 |
2,345 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
7,811 |
7,109 |
$106K |
| D1110 |
Prophylaxis - adult |
3,724 |
3,388 |
$104K |
| D0272 |
Bitewings - two radiographic images |
6,286 |
5,646 |
$91K |
| D0330 |
Panoramic radiographic image |
2,823 |
2,526 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,191 |
1,360 |
$81K |
| D1351 |
Sealant - per tooth |
4,071 |
1,149 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,911 |
2,594 |
$58K |
| D2940 |
|
962 |
620 |
$23K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
183 |
125 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
840 |
718 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
633 |
553 |
$3K |
| D2160 |
|
61 |
53 |
$3K |
| D2330 |
|
16 |
13 |
$356.70 |