| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,848 |
1,637 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,689 |
1,483 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,236 |
1,058 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
684 |
426 |
$16K |
| D1999 |
|
1,056 |
951 |
$13K |
| D1351 |
Sealant - per tooth |
992 |
105 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
303 |
217 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
555 |
461 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
424 |
353 |
$6K |
| D1120 |
Prophylaxis - child |
324 |
262 |
$5K |
| D2140 |
|
223 |
143 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
298 |
247 |
$4K |
| D2330 |
|
160 |
71 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
573 |
486 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
29 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
280 |
167 |
$951.40 |