| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,786 |
6,279 |
$211K |
| D1999 |
|
9,917 |
7,832 |
$151K |
| D0330 |
Panoramic radiographic image |
4,006 |
3,214 |
$114K |
| D0272 |
Bitewings - two radiographic images |
5,794 |
4,652 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,172 |
3,389 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
4,973 |
3,951 |
$69K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,707 |
1,013 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,254 |
1,809 |
$32K |
| D2140 |
|
997 |
587 |
$28K |
| D2160 |
|
528 |
268 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
728 |
446 |
$22K |
| D1120 |
Prophylaxis - child |
842 |
693 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
869 |
699 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
231 |
174 |
$4K |
| D1351 |
Sealant - per tooth |
241 |
29 |
$3K |
| D2332 |
|
39 |
12 |
$2K |
| D2331 |
|
38 |
14 |
$1K |
| D2330 |
|
41 |
25 |
$1K |
| D2335 |
|
19 |
12 |
$643.65 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
13 |
$57.00 |