| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,019 |
3,869 |
$94K |
| D0272 |
Bitewings - two radiographic images |
3,415 |
3,261 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
4,099 |
3,948 |
$48K |
| D1351 |
Sealant - per tooth |
2,655 |
335 |
$37K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,015 |
634 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,228 |
2,140 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,459 |
1,394 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,802 |
3,799 |
$25K |
| D1120 |
Prophylaxis - child |
1,356 |
1,312 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,565 |
3,400 |
$22K |
| D1999 |
|
936 |
842 |
$22K |
| D2160 |
|
334 |
262 |
$12K |
| D2140 |
|
363 |
228 |
$9K |
| D2335 |
|
94 |
67 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
39 |
$2K |
| D2330 |
|
45 |
24 |
$2K |
| D2940 |
|
64 |
42 |
$1K |
| D2161 |
|
12 |
12 |
$526.75 |