| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
5,397 |
4,459 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
911 |
432 |
$59K |
| D1120 |
Prophylaxis - child |
2,959 |
2,583 |
$58K |
| D2161 |
|
833 |
391 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,768 |
3,313 |
$54K |
| D1351 |
Sealant - per tooth |
2,271 |
427 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,301 |
1,990 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
594 |
367 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,187 |
1,050 |
$28K |
| D2160 |
|
318 |
201 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
289 |
245 |
$14K |
| D1110 |
Prophylaxis - adult |
445 |
378 |
$13K |
| D0272 |
Bitewings - two radiographic images |
886 |
774 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,521 |
1,077 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,430 |
1,259 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
148 |
97 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$249.36 |