| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
884 |
472 |
$33K |
| D2140 |
|
444 |
107 |
$17K |
| D1999 |
|
1,124 |
511 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
792 |
422 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
234 |
83 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
150 |
63 |
$11K |
| D0272 |
Bitewings - two radiographic images |
539 |
271 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
171 |
$8K |
| D1351 |
Sealant - per tooth |
476 |
40 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
160 |
26 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
456 |
238 |
$7K |
| D2330 |
|
152 |
28 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
612 |
158 |
$5K |
| D1120 |
Prophylaxis - child |
215 |
109 |
$5K |
| D2160 |
|
82 |
35 |
$5K |
| D2331 |
|
79 |
19 |
$4K |
| D2335 |
|
50 |
13 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
339 |
177 |
$3K |
| D2940 |
|
33 |
16 |
$906.25 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
13 |
$546.00 |