| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
3,174 |
2,297 |
$47K |
| D1351 |
Sealant - per tooth |
2,505 |
405 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,105 |
1,034 |
$16K |
| D1120 |
Prophylaxis - child |
809 |
748 |
$15K |
| D2335 |
|
350 |
117 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
986 |
912 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,049 |
968 |
$12K |
| D1110 |
Prophylaxis - adult |
514 |
483 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
311 |
206 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
409 |
386 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
275 |
90 |
$6K |
| D0330 |
Panoramic radiographic image |
151 |
147 |
$4K |
| D2940 |
|
135 |
82 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
57 |
24 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
160 |
67 |
$3K |
| D0272 |
Bitewings - two radiographic images |
112 |
105 |
$1K |
| D2140 |
|
47 |
15 |
$691.20 |
| D7510 |
|
48 |
46 |
$594.00 |
| D2160 |
|
23 |
12 |
$537.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
60 |
12 |
$216.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$59.40 |