| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,468 |
6,899 |
$226K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,356 |
3,072 |
$209K |
| D1999 |
|
9,688 |
7,726 |
$136K |
| D0330 |
Panoramic radiographic image |
4,164 |
3,496 |
$118K |
| D0272 |
Bitewings - two radiographic images |
7,740 |
6,366 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,716 |
4,756 |
$105K |
| D2160 |
|
2,151 |
1,504 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
5,512 |
4,479 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,571 |
2,924 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,143 |
711 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
6,029 |
4,922 |
$41K |
| D2140 |
|
1,171 |
831 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,057 |
3,470 |
$36K |
| D1120 |
Prophylaxis - child |
1,847 |
1,526 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
929 |
826 |
$14K |
| D2335 |
|
170 |
144 |
$10K |
| D2330 |
|
110 |
82 |
$3K |
| D2940 |
|
115 |
81 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
12 |
$2K |
| D2331 |
|
32 |
24 |
$1K |
| D2161 |
|
27 |
24 |
$1K |
| D3221 |
|
24 |
24 |
$573.09 |
| D1330 |
|
231 |
118 |
$0.00 |