| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,318 |
3,678 |
$109K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,133 |
1,333 |
$63K |
| D1999 |
|
3,668 |
3,456 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
4,068 |
3,456 |
$48K |
| D2140 |
|
1,899 |
875 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
1,040 |
924 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,492 |
2,136 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,168 |
739 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,391 |
2,017 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,935 |
1,604 |
$26K |
| D1120 |
Prophylaxis - child |
1,371 |
1,142 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,355 |
1,183 |
$19K |
| D2160 |
|
363 |
123 |
$19K |
| D2330 |
|
482 |
260 |
$11K |
| D0330 |
Panoramic radiographic image |
345 |
255 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,559 |
1,181 |
$8K |
| D2940 |
|
210 |
165 |
$4K |
| D2331 |
|
100 |
62 |
$3K |
| D2332 |
|
68 |
52 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
22 |
$165.52 |