| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,443 |
4,236 |
$118K |
| D1999 |
|
4,515 |
4,172 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
4,350 |
4,195 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,139 |
3,517 |
$53K |
| D2335 |
|
1,167 |
261 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,886 |
2,761 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,020 |
1,933 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,338 |
3,190 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,126 |
1,022 |
$22K |
| D1120 |
Prophylaxis - child |
909 |
860 |
$17K |
| D2140 |
|
425 |
227 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
295 |
174 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
200 |
128 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
208 |
187 |
$3K |
| D1351 |
Sealant - per tooth |
153 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
24 |
$1K |