| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,063 |
8,755 |
$239K |
| D1999 |
|
10,049 |
9,682 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
8,560 |
8,296 |
$119K |
| D0330 |
Panoramic radiographic image |
3,933 |
3,776 |
$112K |
| D0272 |
Bitewings - two radiographic images |
6,502 |
6,251 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,394 |
4,230 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,644 |
5,467 |
$79K |
| D1120 |
Prophylaxis - child |
3,487 |
3,384 |
$65K |
| D2140 |
|
706 |
391 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
484 |
333 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
380 |
285 |
$11K |
| D1351 |
Sealant - per tooth |
398 |
43 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
113 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
219 |
200 |
$1K |
| D2330 |
|
37 |
20 |
$809.00 |
| D2161 |
|
20 |
13 |
$645.20 |
| D2160 |
|
13 |
13 |
$385.80 |