| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,683 |
6,671 |
$221K |
| D1999 |
|
10,469 |
8,974 |
$151K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,697 |
2,051 |
$150K |
| D0330 |
Panoramic radiographic image |
4,240 |
3,689 |
$128K |
| D0272 |
Bitewings - two radiographic images |
5,930 |
5,172 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,619 |
3,202 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
5,034 |
4,370 |
$71K |
| D2160 |
|
1,317 |
948 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,734 |
2,336 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
597 |
427 |
$24K |
| D1120 |
Prophylaxis - child |
1,282 |
1,090 |
$24K |
| D2140 |
|
788 |
517 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
980 |
865 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,510 |
1,319 |
$10K |
| D2330 |
|
229 |
70 |
$7K |
| D1351 |
Sealant - per tooth |
300 |
42 |
$4K |
| D2335 |
|
33 |
13 |
$2K |
| D2332 |
|
35 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
211 |
135 |
$779.05 |
| D9995 |
|
16 |
13 |
$152.50 |