| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
7,823 |
3,785 |
$127K |
| D1110 |
Prophylaxis - adult |
3,892 |
3,456 |
$106K |
| D1999 |
|
6,684 |
5,125 |
$104K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,434 |
827 |
$60K |
| D0272 |
Bitewings - two radiographic images |
3,863 |
3,454 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,230 |
1,974 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,949 |
2,601 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,534 |
4,079 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,828 |
1,582 |
$25K |
| D2160 |
|
464 |
290 |
$23K |
| D1120 |
Prophylaxis - child |
1,032 |
881 |
$19K |
| D1351 |
Sealant - per tooth |
1,110 |
108 |
$16K |
| D2140 |
|
367 |
202 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
530 |
494 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
141 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
48 |
41 |
$4K |
| D2330 |
|
34 |
12 |
$962.94 |