| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
11,664 |
9,249 |
$162K |
| D1110 |
Prophylaxis - adult |
5,412 |
4,383 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,091 |
3,327 |
$90K |
| D0330 |
Panoramic radiographic image |
2,814 |
2,283 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
4,862 |
3,839 |
$69K |
| D1351 |
Sealant - per tooth |
4,592 |
708 |
$68K |
| D1120 |
Prophylaxis - child |
3,353 |
2,660 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,551 |
3,654 |
$63K |
| D0272 |
Bitewings - two radiographic images |
4,281 |
3,509 |
$60K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
943 |
561 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,138 |
1,144 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
455 |
240 |
$22K |
| D2140 |
|
623 |
322 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,942 |
1,556 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
199 |
163 |
$4K |
| D2160 |
|
62 |
43 |
$3K |
| D0191 |
|
25 |
15 |
$0.00 |