| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
4,489 |
3,728 |
$65K |
| D1110 |
Prophylaxis - adult |
2,198 |
1,843 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,603 |
2,156 |
$36K |
| D1120 |
Prophylaxis - child |
1,777 |
1,476 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,738 |
1,450 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,337 |
1,940 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
593 |
368 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,811 |
1,521 |
$25K |
| D2140 |
|
846 |
409 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,707 |
879 |
$20K |
| D1351 |
Sealant - per tooth |
1,110 |
137 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
239 |
156 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,246 |
1,001 |
$7K |
| D0330 |
Panoramic radiographic image |
215 |
200 |
$6K |
| D2335 |
|
84 |
39 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
239 |
197 |
$3K |
| D2940 |
|
62 |
46 |
$1K |
| D9995 |
|
13 |
13 |
$154.00 |