| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,939 |
1,574 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,222 |
1,664 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,591 |
2,083 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
747 |
399 |
$18K |
| D2140 |
|
849 |
249 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,080 |
1,719 |
$13K |
| D1999 |
|
933 |
787 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
832 |
656 |
$11K |
| D0272 |
Bitewings - two radiographic images |
774 |
643 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
188 |
140 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
348 |
164 |
$9K |
| D1120 |
Prophylaxis - child |
457 |
364 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
403 |
328 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
51 |
$959.95 |
| D1351 |
Sealant - per tooth |
60 |
13 |
$756.00 |
| D9995 |
|
33 |
33 |
$308.00 |