| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,252 |
9,900 |
$297K |
| D1999 |
|
10,833 |
9,725 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
10,153 |
9,165 |
$140K |
| D0272 |
Bitewings - two radiographic images |
7,899 |
6,923 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,937 |
7,738 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,025 |
3,472 |
$56K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,416 |
991 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,864 |
2,481 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
7,140 |
6,308 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,247 |
876 |
$46K |
| D1120 |
Prophylaxis - child |
1,850 |
1,630 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,893 |
1,683 |
$32K |
| D2335 |
|
394 |
283 |
$26K |
| D1351 |
Sealant - per tooth |
1,740 |
291 |
$25K |
| D2140 |
|
743 |
470 |
$23K |
| D2160 |
|
233 |
204 |
$10K |
| D3320 |
|
16 |
15 |
$3K |
| D2331 |
|
13 |
12 |
$603.63 |
| D2940 |
|
12 |
12 |
$370.00 |