| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,484 |
4,051 |
$112K |
| D2140 |
|
3,501 |
1,356 |
$96K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,291 |
1,148 |
$78K |
| D1999 |
|
4,686 |
4,277 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,994 |
2,695 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,159 |
2,631 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
3,948 |
3,626 |
$50K |
| D1351 |
Sealant - per tooth |
3,718 |
476 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,610 |
2,386 |
$35K |
| D1120 |
Prophylaxis - child |
1,625 |
1,491 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
3,275 |
2,950 |
$21K |
| D0330 |
Panoramic radiographic image |
564 |
492 |
$18K |
| D2335 |
|
278 |
151 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
431 |
292 |
$16K |
| D0272 |
Bitewings - two radiographic images |
940 |
861 |
$12K |
| D2331 |
|
234 |
55 |
$9K |
| D2160 |
|
190 |
138 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
82 |
63 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
185 |
$4K |
| D2332 |
|
18 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
14 |
$673.10 |
| D2330 |
|
26 |
12 |
$460.82 |
| D2161 |
|
16 |
13 |
$357.40 |