| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,928 |
7,237 |
$223K |
| D0120 |
Periodic oral evaluation - established patient |
8,365 |
7,593 |
$114K |
| D1999 |
|
7,699 |
7,076 |
$113K |
| D0330 |
Panoramic radiographic image |
3,514 |
3,159 |
$104K |
| D0272 |
Bitewings - two radiographic images |
5,606 |
5,069 |
$82K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,780 |
1,259 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,403 |
3,052 |
$48K |
| D2140 |
|
1,467 |
909 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,102 |
749 |
$40K |
| D1120 |
Prophylaxis - child |
1,866 |
1,651 |
$35K |
| D2160 |
|
756 |
607 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,291 |
1,179 |
$25K |
| D2335 |
|
348 |
202 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
594 |
539 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
784 |
724 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
102 |
52 |
$4K |
| D2161 |
|
50 |
38 |
$3K |
| D7250 |
|
25 |
12 |
$1K |
| D2330 |
|
38 |
25 |
$1K |
| D2331 |
|
23 |
14 |
$995.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
121 |
59 |
$670.34 |