| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,275 |
3,053 |
$88K |
| D0330 |
Panoramic radiographic image |
1,627 |
1,500 |
$46K |
| D1999 |
|
2,959 |
2,750 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,855 |
1,689 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,410 |
2,220 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,354 |
2,201 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,212 |
1,098 |
$17K |
| D2335 |
|
307 |
111 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
438 |
266 |
$11K |
| D1120 |
Prophylaxis - child |
623 |
556 |
$11K |
| D2140 |
|
339 |
198 |
$7K |
| D2160 |
|
140 |
92 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
98 |
$4K |
| D2330 |
|
114 |
40 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
41 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
200 |
187 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
646 |
276 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
444 |
361 |
$2K |
| D2940 |
|
96 |
64 |
$2K |
| D2332 |
|
32 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
66 |
14 |
$1K |
| D9995 |
|
25 |
23 |
$140.00 |
| D2710 |
|
151 |
38 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
124 |
13 |
$0.00 |