| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,047 |
6,760 |
$178K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,051 |
1,683 |
$120K |
| D1999 |
|
7,124 |
6,765 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
6,194 |
5,971 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,734 |
7,125 |
$73K |
| D0272 |
Bitewings - two radiographic images |
4,961 |
4,759 |
$70K |
| D2160 |
|
1,252 |
868 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,238 |
2,123 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,426 |
2,307 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
4,271 |
4,100 |
$31K |
| D1120 |
Prophylaxis - child |
1,523 |
1,466 |
$27K |
| D0330 |
Panoramic radiographic image |
793 |
769 |
$24K |
| D2140 |
|
400 |
254 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
104 |
$6K |
| D2332 |
|
69 |
44 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
197 |
190 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
28 |
$3K |
| D2335 |
|
54 |
37 |
$3K |
| D2161 |
|
38 |
31 |
$2K |
| D2331 |
|
20 |
12 |
$882.46 |