| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
17,773 |
17,000 |
$467K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,604 |
1,987 |
$436K |
| D1999 |
|
19,945 |
19,202 |
$292K |
| D2332 |
|
3,872 |
1,530 |
$238K |
| D0120 |
Periodic oral evaluation - established patient |
16,327 |
15,593 |
$227K |
| D0272 |
Bitewings - two radiographic images |
13,164 |
12,560 |
$186K |
| D1351 |
Sealant - per tooth |
10,067 |
1,810 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,575 |
14,087 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,856 |
5,606 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,607 |
8,173 |
$118K |
| D2330 |
|
2,801 |
1,049 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
13,910 |
13,276 |
$107K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,380 |
1,693 |
$98K |
| D2331 |
|
1,880 |
871 |
$94K |
| D1120 |
Prophylaxis - child |
4,799 |
4,579 |
$87K |
| D2160 |
|
1,505 |
1,117 |
$77K |
| D2335 |
|
767 |
450 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
733 |
460 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
397 |
368 |
$7K |
| D2140 |
|
101 |
80 |
$3K |