| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,295 |
2,082 |
$63K |
| D2335 |
|
834 |
404 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,225 |
714 |
$42K |
| D1999 |
|
2,641 |
2,175 |
$39K |
| D2330 |
|
1,274 |
507 |
$38K |
| D2140 |
|
1,090 |
521 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,131 |
953 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
471 |
421 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
347 |
207 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,248 |
1,184 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
270 |
114 |
$8K |
| D2160 |
|
135 |
75 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
175 |
53 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
168 |
152 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
321 |
254 |
$2K |
| D0272 |
Bitewings - two radiographic images |
105 |
73 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
51 |
$667.42 |
| D1120 |
Prophylaxis - child |
26 |
26 |
$421.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
25 |
$129.60 |