| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,408 |
5,391 |
$161K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,405 |
7,479 |
$117K |
| D1999 |
|
6,289 |
5,104 |
$93K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,099 |
791 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,979 |
3,362 |
$76K |
| D0272 |
Bitewings - two radiographic images |
5,170 |
4,336 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
4,162 |
3,500 |
$54K |
| D2140 |
|
1,787 |
740 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,990 |
1,653 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,844 |
1,443 |
$12K |
| D1120 |
Prophylaxis - child |
607 |
498 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
199 |
129 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
156 |
139 |
$2K |
| D1351 |
Sealant - per tooth |
112 |
13 |
$1K |
| D2331 |
|
25 |
17 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
19 |
$742.50 |
| D2160 |
|
19 |
13 |
$602.00 |