| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,004 |
4,515 |
$137K |
| D0210 |
Intraoral - complete series of radiographic images |
1,750 |
1,598 |
$75K |
| D1999 |
|
4,029 |
3,574 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
3,760 |
3,377 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
989 |
490 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,171 |
1,083 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,144 |
1,012 |
$17K |
| D2160 |
|
336 |
222 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
931 |
824 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
226 |
135 |
$8K |
| D2140 |
|
265 |
147 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
43 |
$2K |
| D1351 |
Sealant - per tooth |
103 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$201.88 |