| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,694 |
2,206 |
$75K |
| D1999 |
|
4,654 |
3,835 |
$69K |
| D2140 |
|
1,835 |
1,003 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,520 |
948 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,749 |
1,479 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,267 |
1,904 |
$33K |
| D0330 |
Panoramic radiographic image |
1,050 |
920 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,730 |
1,363 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
645 |
393 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,296 |
1,028 |
$18K |
| D1120 |
Prophylaxis - child |
585 |
476 |
$11K |
| D2160 |
|
105 |
82 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
80 |
49 |
$3K |
| D1351 |
Sealant - per tooth |
147 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
196 |
173 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
43 |
$860.12 |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
38 |
$221.25 |