| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2332 |
|
3,380 |
548 |
$237K |
| D9110 |
|
1,013 |
793 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,634 |
1,548 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
579 |
221 |
$27K |
| D1110 |
Prophylaxis - adult |
944 |
903 |
$26K |
| D1120 |
Prophylaxis - child |
1,039 |
981 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,033 |
975 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,547 |
1,364 |
$13K |
| D0272 |
Bitewings - two radiographic images |
878 |
842 |
$12K |
| D2140 |
|
194 |
106 |
$7K |
| D2161 |
|
126 |
72 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
525 |
478 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
154 |
149 |
$3K |
| D1351 |
Sealant - per tooth |
154 |
29 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
24 |
$3K |
| D2160 |
|
27 |
24 |
$2K |
| D0330 |
Panoramic radiographic image |
36 |
26 |
$945.00 |
| D0140 |
Limited oral evaluation - problem focused |
42 |
37 |
$642.03 |