| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,487 |
3,695 |
$126K |
| D1999 |
|
7,025 |
5,792 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
5,643 |
4,631 |
$80K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,631 |
980 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,569 |
2,939 |
$50K |
| D1120 |
Prophylaxis - child |
2,217 |
1,809 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,619 |
2,203 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,683 |
583 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,083 |
880 |
$18K |
| D2140 |
|
495 |
340 |
$16K |
| D2160 |
|
269 |
195 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
780 |
647 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
75 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
52 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
155 |
143 |
$3K |
| D1351 |
Sealant - per tooth |
108 |
12 |
$2K |