| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,249 |
2,005 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,647 |
1,845 |
$34K |
| D1999 |
|
1,983 |
1,689 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,133 |
1,898 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,374 |
1,211 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
626 |
395 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,212 |
1,024 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,352 |
1,182 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,223 |
1,952 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
621 |
387 |
$12K |
| D1120 |
Prophylaxis - child |
705 |
586 |
$9K |
| D2335 |
|
227 |
121 |
$8K |
| D1351 |
Sealant - per tooth |
494 |
57 |
$6K |
| D2140 |
|
255 |
187 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
345 |
314 |
$3K |
| D2161 |
|
101 |
78 |
$3K |
| D2160 |
|
63 |
45 |
$2K |
| D2940 |
|
29 |
26 |
$430.00 |