| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,992 |
1,727 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,561 |
1,264 |
$30K |
| D1999 |
|
1,865 |
1,717 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,661 |
1,445 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,810 |
1,980 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,144 |
1,824 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
1,007 |
945 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
827 |
677 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
479 |
474 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
228 |
184 |
$8K |
| D1120 |
Prophylaxis - child |
324 |
312 |
$6K |
| D2140 |
|
163 |
119 |
$5K |
| D1351 |
Sealant - per tooth |
194 |
25 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
36 |
$2K |
| D2160 |
|
60 |
48 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
25 |
$2K |
| D2332 |
|
24 |
14 |
$781.00 |
| D2940 |
|
20 |
17 |
$615.50 |