| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,881 |
5,504 |
$148K |
| D2140 |
|
4,052 |
1,884 |
$126K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,476 |
1,505 |
$96K |
| D1999 |
|
5,582 |
5,218 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,698 |
1,149 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
5,043 |
4,715 |
$66K |
| D0272 |
Bitewings - two radiographic images |
4,280 |
4,039 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,790 |
3,281 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,709 |
2,541 |
$54K |
| D1351 |
Sealant - per tooth |
3,294 |
502 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,140 |
2,932 |
$43K |
| D1120 |
Prophylaxis - child |
1,781 |
1,663 |
$31K |
| D2330 |
|
980 |
389 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
632 |
168 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,856 |
2,698 |
$21K |
| D2331 |
|
341 |
118 |
$12K |
| D2160 |
|
99 |
78 |
$5K |
| D2332 |
|
20 |
13 |
$720.00 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$519.35 |