| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
4,895 |
4,237 |
$70K |
| D1110 |
Prophylaxis - adult |
2,452 |
2,140 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,035 |
650 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,657 |
1,373 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,130 |
1,933 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,895 |
1,615 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,783 |
1,526 |
$25K |
| D1120 |
Prophylaxis - child |
1,253 |
1,098 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,148 |
629 |
$20K |
| D2140 |
|
506 |
332 |
$17K |
| D0330 |
Panoramic radiographic image |
475 |
381 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
919 |
804 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
89 |
$2K |
| D2160 |
|
35 |
27 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
26 |
$922.50 |