| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
12,014 |
10,241 |
$176K |
| D1110 |
Prophylaxis - adult |
5,398 |
4,567 |
$152K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,107 |
1,772 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
8,409 |
6,978 |
$120K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,400 |
1,410 |
$110K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,434 |
6,097 |
$105K |
| D1120 |
Prophylaxis - child |
5,378 |
4,368 |
$103K |
| D0330 |
Panoramic radiographic image |
3,489 |
2,878 |
$102K |
| D0272 |
Bitewings - two radiographic images |
6,219 |
5,167 |
$89K |
| D2140 |
|
1,616 |
984 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,374 |
1,994 |
$50K |
| D1351 |
Sealant - per tooth |
2,910 |
556 |
$42K |
| D2160 |
|
555 |
369 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
844 |
704 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
221 |
123 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,058 |
889 |
$7K |
| D2940 |
|
122 |
99 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
14 |
$1K |