| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,942 |
8,786 |
$278K |
| D1999 |
|
11,108 |
9,856 |
$159K |
| D0330 |
Panoramic radiographic image |
4,563 |
3,928 |
$135K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,321 |
2,168 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
8,369 |
7,407 |
$117K |
| D0272 |
Bitewings - two radiographic images |
6,935 |
6,150 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,602 |
3,139 |
$73K |
| D2160 |
|
1,297 |
945 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,065 |
3,510 |
$57K |
| D2140 |
|
1,491 |
1,015 |
$45K |
| D1351 |
Sealant - per tooth |
2,802 |
387 |
$40K |
| D1120 |
Prophylaxis - child |
1,835 |
1,573 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,672 |
2,481 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,607 |
2,340 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
371 |
228 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
363 |
325 |
$6K |
| D2330 |
|
152 |
85 |
$5K |
| D2331 |
|
82 |
56 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
52 |
$3K |
| D9995 |
|
304 |
255 |
$2K |
| D2940 |
|
46 |
44 |
$1K |