| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,676 |
6,346 |
$220K |
| D1999 |
|
7,320 |
5,990 |
$108K |
| D0272 |
Bitewings - two radiographic images |
6,036 |
5,014 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
6,114 |
4,987 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,651 |
3,071 |
$77K |
| D2335 |
|
659 |
451 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,029 |
755 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,915 |
2,381 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
891 |
532 |
$32K |
| D1120 |
Prophylaxis - child |
1,495 |
1,222 |
$28K |
| D2140 |
|
848 |
572 |
$28K |
| D1351 |
Sealant - per tooth |
1,412 |
317 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
329 |
233 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
361 |
230 |
$16K |
| D2160 |
|
263 |
226 |
$12K |
| D0330 |
Panoramic radiographic image |
360 |
342 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,650 |
1,379 |
$9K |
| D2332 |
|
146 |
92 |
$8K |
| D2330 |
|
152 |
96 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
232 |
232 |
$4K |
| D2940 |
|
53 |
43 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
117 |
70 |
$1K |
| D7250 |
|
17 |
15 |
$880.90 |
| D2161 |
|
15 |
14 |
$544.20 |