| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,159 |
2,986 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,183 |
797 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
2,724 |
2,583 |
$31K |
| D2330 |
|
986 |
204 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,400 |
1,272 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
449 |
304 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
911 |
825 |
$12K |
| D2140 |
|
490 |
266 |
$11K |
| D1120 |
Prophylaxis - child |
586 |
519 |
$9K |
| D1999 |
|
397 |
385 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
473 |
463 |
$4K |
| D1351 |
Sealant - per tooth |
199 |
15 |
$2K |
| D2331 |
|
34 |
15 |
$1K |
| D2335 |
|
19 |
13 |
$739.50 |
| D2160 |
|
19 |
16 |
$584.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
14 |
$152.06 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$148.50 |
| D9410 |
|
130 |
130 |
$0.00 |