| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,178 |
4,521 |
$130K |
| D1999 |
|
5,746 |
5,043 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,038 |
3,506 |
$75K |
| D0330 |
Panoramic radiographic image |
2,275 |
1,976 |
$60K |
| D0272 |
Bitewings - two radiographic images |
4,196 |
3,656 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
3,142 |
2,728 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,651 |
2,263 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
926 |
544 |
$31K |
| D1120 |
Prophylaxis - child |
1,725 |
1,476 |
$30K |
| D2140 |
|
413 |
210 |
$13K |
| D2160 |
|
147 |
109 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
594 |
550 |
$4K |
| D2335 |
|
87 |
44 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
240 |
207 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
319 |
125 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
120 |
79 |
$2K |
| D1351 |
Sealant - per tooth |
129 |
16 |
$2K |
| D2331 |
|
18 |
13 |
$511.00 |
| D2940 |
|
17 |
16 |
$244.00 |