| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,271 |
2,164 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,463 |
2,473 |
$57K |
| D1999 |
|
3,401 |
3,142 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,073 |
1,975 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,982 |
1,892 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,184 |
1,103 |
$24K |
| D2140 |
|
619 |
351 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
447 |
309 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,449 |
2,318 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,255 |
1,168 |
$17K |
| D1351 |
Sealant - per tooth |
851 |
154 |
$12K |
| D1120 |
Prophylaxis - child |
653 |
598 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
40 |
$2K |