| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,245 |
4,878 |
$180K |
| D1999 |
|
7,280 |
6,139 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
6,650 |
4,928 |
$91K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,831 |
991 |
$69K |
| D0272 |
Bitewings - two radiographic images |
4,670 |
3,626 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,374 |
2,502 |
$48K |
| D0330 |
Panoramic radiographic image |
1,427 |
1,259 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,483 |
1,336 |
$35K |
| D1120 |
Prophylaxis - child |
1,713 |
1,227 |
$32K |
| D2140 |
|
984 |
517 |
$28K |
| D2160 |
|
471 |
239 |
$19K |
| D1351 |
Sealant - per tooth |
892 |
78 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,108 |
1,087 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
738 |
492 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
71 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
256 |
185 |
$4K |
| D2332 |
|
19 |
12 |
$677.92 |