| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,779 |
3,550 |
$103K |
| D1999 |
|
5,106 |
4,661 |
$75K |
| D0330 |
Panoramic radiographic image |
2,337 |
2,187 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,173 |
676 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,325 |
2,185 |
$50K |
| D0272 |
Bitewings - two radiographic images |
3,334 |
3,125 |
$47K |
| D1351 |
Sealant - per tooth |
2,974 |
499 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,826 |
2,657 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,979 |
1,849 |
$28K |
| D1120 |
Prophylaxis - child |
1,187 |
1,106 |
$22K |
| D2140 |
|
607 |
357 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
40 |
$4K |
| D2160 |
|
46 |
37 |
$3K |
| D2335 |
|
30 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
20 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
100 |
$801.67 |
| D0140 |
Limited oral evaluation - problem focused |
47 |
42 |
$493.52 |