| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
9,707 |
7,157 |
$135K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,036 |
1,124 |
$121K |
| D1110 |
Prophylaxis - adult |
2,780 |
2,319 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,591 |
2,229 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
829 |
768 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
308 |
135 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,987 |
1,671 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
619 |
377 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,491 |
1,267 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,179 |
964 |
$18K |
| D1120 |
Prophylaxis - child |
971 |
839 |
$17K |
| D0272 |
Bitewings - two radiographic images |
872 |
732 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
927 |
727 |
$7K |
| D2140 |
|
255 |
140 |
$5K |
| D1351 |
Sealant - per tooth |
407 |
104 |
$5K |
| D2330 |
|
148 |
67 |
$5K |
| D0330 |
Panoramic radiographic image |
200 |
184 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
622 |
509 |
$4K |
| D3310 |
|
17 |
12 |
$2K |
| D2331 |
|
23 |
13 |
$739.50 |
| D2160 |
|
20 |
12 |
$626.80 |
| D0470 |
|
26 |
26 |
$0.00 |