| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,378 |
5,977 |
$199K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,519 |
1,004 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
5,980 |
4,811 |
$79K |
| D1999 |
|
6,030 |
4,624 |
$74K |
| D0272 |
Bitewings - two radiographic images |
5,152 |
4,173 |
$73K |
| D2160 |
|
1,518 |
981 |
$65K |
| D2335 |
|
1,012 |
511 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,663 |
1,037 |
$55K |
| D2330 |
|
1,328 |
647 |
$46K |
| D2140 |
|
1,347 |
842 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,707 |
4,025 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,973 |
1,597 |
$36K |
| D0330 |
Panoramic radiographic image |
1,114 |
975 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
4,221 |
3,298 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,228 |
961 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
784 |
674 |
$13K |
| D2161 |
|
241 |
166 |
$11K |
| D2332 |
|
172 |
88 |
$8K |
| D1120 |
Prophylaxis - child |
493 |
366 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
159 |
96 |
$4K |