| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,779 |
7,974 |
$274K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,216 |
5,450 |
$172K |
| D1999 |
|
9,565 |
7,520 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
10,076 |
8,199 |
$143K |
| D0272 |
Bitewings - two radiographic images |
6,575 |
5,443 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,080 |
1,355 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,098 |
3,404 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
6,685 |
5,544 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,003 |
1,726 |
$38K |
| D1120 |
Prophylaxis - child |
1,878 |
1,598 |
$35K |
| D1351 |
Sealant - per tooth |
2,109 |
269 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
399 |
298 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
857 |
741 |
$15K |
| D2140 |
|
483 |
269 |
$14K |