| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,865 |
3,214 |
$107K |
| D1999 |
|
3,699 |
3,219 |
$58K |
| D0272 |
Bitewings - two radiographic images |
3,019 |
2,500 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,987 |
2,461 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,628 |
1,365 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,511 |
1,219 |
$21K |
| D2140 |
|
620 |
301 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
401 |
248 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
351 |
228 |
$11K |
| D1120 |
Prophylaxis - child |
569 |
458 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,193 |
1,025 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,251 |
777 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
390 |
337 |
$6K |
| D2335 |
|
57 |
30 |
$3K |
| D2160 |
|
49 |
26 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
16 |
$946.60 |
| D9996 |
|
55 |
52 |
$684.50 |
| D2940 |
|
36 |
26 |
$622.70 |