| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
37,808 |
26,948 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
5,158 |
4,734 |
$123K |
| D1120 |
Prophylaxis - child |
2,837 |
2,527 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,986 |
3,634 |
$64K |
| D1110 |
Prophylaxis - adult |
1,447 |
1,312 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,553 |
2,250 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
384 |
302 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
371 |
265 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
729 |
655 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,956 |
1,731 |
$26K |
| D1351 |
Sealant - per tooth |
1,099 |
221 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
449 |
405 |
$15K |
| D0330 |
Panoramic radiographic image |
53 |
50 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
228 |
151 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
26 |
$2K |