| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,063 |
6,039 |
$192K |
| D0330 |
Panoramic radiographic image |
3,827 |
3,218 |
$110K |
| D1999 |
|
6,491 |
5,369 |
$104K |
| D0272 |
Bitewings - two radiographic images |
5,929 |
5,035 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
5,613 |
4,778 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,416 |
2,981 |
$68K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,706 |
925 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,666 |
3,102 |
$52K |
| D2140 |
|
1,714 |
912 |
$51K |
| D1120 |
Prophylaxis - child |
1,639 |
1,428 |
$30K |
| D1351 |
Sealant - per tooth |
852 |
117 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
201 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
552 |
486 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
56 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
804 |
727 |
$5K |
| D2160 |
|
110 |
77 |
$4K |
| D2335 |
|
29 |
13 |
$1K |
| D2330 |
|
24 |
12 |
$895.77 |
| D0230 |
Intraoral - periapical each additional radiographic image |
63 |
53 |
$501.40 |