| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,289 |
9,304 |
$273K |
| D1999 |
|
12,015 |
10,313 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
10,046 |
9,047 |
$139K |
| D0330 |
Panoramic radiographic image |
4,059 |
3,679 |
$118K |
| D2140 |
|
3,542 |
2,226 |
$112K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,625 |
1,799 |
$104K |
| D0272 |
Bitewings - two radiographic images |
6,778 |
6,159 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,422 |
3,968 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,876 |
2,629 |
$59K |
| D1120 |
Prophylaxis - child |
2,694 |
2,448 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
871 |
430 |
$31K |
| D2160 |
|
504 |
393 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
733 |
469 |
$21K |
| D2940 |
|
675 |
592 |
$15K |
| D2330 |
|
464 |
264 |
$14K |
| D2331 |
|
144 |
104 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
622 |
490 |
$4K |
| D1351 |
Sealant - per tooth |
142 |
36 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
308 |
254 |
$2K |
| D2332 |
|
14 |
12 |
$902.81 |
| D0140 |
Limited oral evaluation - problem focused |
31 |
28 |
$561.72 |