| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,790 |
6,225 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
6,132 |
5,707 |
$80K |
| D1999 |
|
4,633 |
4,510 |
$68K |
| D0272 |
Bitewings - two radiographic images |
4,705 |
4,278 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,710 |
2,317 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,936 |
4,197 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,229 |
2,872 |
$43K |
| D1120 |
Prophylaxis - child |
2,033 |
1,808 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
4,615 |
4,206 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
789 |
506 |
$21K |
| D2140 |
|
294 |
206 |
$5K |
| D2160 |
|
135 |
107 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
226 |
198 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
154 |
101 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$963.60 |
| D2330 |
|
34 |
24 |
$513.50 |
| D2331 |
|
15 |
12 |
$463.50 |