| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,996 |
7,280 |
$204K |
| D2140 |
|
7,007 |
2,033 |
$189K |
| D1999 |
|
10,979 |
5,192 |
$177K |
| D0330 |
Panoramic radiographic image |
5,822 |
4,494 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,627 |
4,462 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,202 |
1,651 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
7,121 |
6,110 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,036 |
4,575 |
$81K |
| D0272 |
Bitewings - two radiographic images |
6,490 |
5,141 |
$78K |
| D1120 |
Prophylaxis - child |
4,327 |
3,315 |
$73K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,024 |
954 |
$65K |
| D2160 |
|
1,178 |
712 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,947 |
1,810 |
$31K |
| D2335 |
|
418 |
270 |
$21K |
| D2161 |
|
140 |
100 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
171 |
102 |
$4K |
| D2330 |
|
71 |
38 |
$2K |
| D2940 |
|
55 |
48 |
$2K |
| D2332 |
|
24 |
14 |
$864.96 |
| D2331 |
|
23 |
15 |
$658.50 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
12 |
$571.20 |