| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,659 |
2,380 |
$77K |
| D0330 |
Panoramic radiographic image |
1,203 |
1,038 |
$36K |
| D1999 |
|
3,074 |
2,496 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
892 |
536 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,022 |
1,796 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,904 |
1,699 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
925 |
802 |
$18K |
| D2140 |
|
583 |
340 |
$14K |
| D2160 |
|
393 |
258 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
406 |
218 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
401 |
330 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
178 |
117 |
$4K |
| D2330 |
|
75 |
41 |
$3K |
| D2335 |
|
38 |
27 |
$3K |
| D2940 |
|
146 |
96 |
$3K |
| D1120 |
Prophylaxis - child |
146 |
125 |
$2K |
| D2332 |
|
42 |
24 |
$2K |
| D2161 |
|
37 |
30 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
55 |
$882.98 |
| D9995 |
|
26 |
24 |
$84.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$57.40 |