| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2332 |
|
966 |
159 |
$58K |
| D1110 |
Prophylaxis - adult |
1,479 |
1,452 |
$45K |
| D2140 |
|
1,240 |
361 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
844 |
335 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
504 |
126 |
$23K |
| D1999 |
|
1,697 |
1,595 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,404 |
895 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
778 |
765 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,050 |
1,033 |
$15K |
| D0272 |
Bitewings - two radiographic images |
956 |
945 |
$14K |
| D0330 |
Panoramic radiographic image |
248 |
245 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
613 |
607 |
$5K |
| D2330 |
|
118 |
26 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
87 |
87 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$709.02 |
| D1120 |
Prophylaxis - child |
38 |
38 |
$661.20 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
14 |
$371.92 |
| D6750 |
|
74 |
25 |
$0.00 |
| D6240 |
|
50 |
26 |
$0.00 |
| D2750 |
|
36 |
17 |
$0.00 |