| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,924 |
4,278 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,550 |
3,222 |
$68K |
| D0272 |
Bitewings - two radiographic images |
3,509 |
3,028 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
3,896 |
3,399 |
$49K |
| D1999 |
|
3,267 |
3,069 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,005 |
1,739 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,088 |
1,809 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
870 |
567 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,583 |
3,078 |
$23K |
| D2140 |
|
664 |
424 |
$19K |
| D1120 |
Prophylaxis - child |
961 |
815 |
$16K |
| D1351 |
Sealant - per tooth |
1,037 |
165 |
$15K |
| D2335 |
|
280 |
138 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
178 |
138 |
$10K |
| D2160 |
|
280 |
203 |
$10K |
| D2161 |
|
166 |
134 |
$7K |
| D2940 |
|
253 |
173 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
235 |
122 |
$5K |
| D2330 |
|
114 |
72 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
73 |
73 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
24 |
$3K |
| D0330 |
Panoramic radiographic image |
76 |
76 |
$2K |