| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
15,261 |
14,354 |
$406K |
| D1999 |
|
17,725 |
16,332 |
$265K |
| D0120 |
Periodic oral evaluation - established patient |
14,349 |
13,489 |
$197K |
| D0330 |
Panoramic radiographic image |
6,282 |
5,795 |
$181K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,467 |
2,801 |
$169K |
| D0272 |
Bitewings - two radiographic images |
11,174 |
10,461 |
$160K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,487 |
2,210 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,008 |
1,220 |
$127K |
| D2140 |
|
4,050 |
2,220 |
$127K |
| D2335 |
|
1,960 |
997 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,207 |
4,776 |
$108K |
| D1351 |
Sealant - per tooth |
7,016 |
941 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,810 |
6,234 |
$95K |
| D1120 |
Prophylaxis - child |
4,101 |
3,731 |
$74K |
| D2160 |
|
1,413 |
1,158 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,492 |
6,745 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
7,644 |
7,186 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
2,872 |
2,550 |
$46K |
| D2330 |
|
1,439 |
762 |
$45K |
| D2940 |
|
1,611 |
1,462 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
428 |
361 |
$38K |
| D2331 |
|
688 |
377 |
$26K |
| D9995 |
|
163 |
156 |
$2K |
| D2161 |
|
14 |
13 |
$435.80 |