| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,298 |
7,265 |
$286K |
| D1999 |
|
11,021 |
8,812 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
6,609 |
5,085 |
$101K |
| D0330 |
Panoramic radiographic image |
2,817 |
2,249 |
$90K |
| D0272 |
Bitewings - two radiographic images |
5,310 |
4,188 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,743 |
2,219 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,427 |
1,084 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
266 |
198 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
941 |
725 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,431 |
1,093 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
55 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
52 |
40 |
$3K |
| D7250 |
|
19 |
13 |
$1K |
| D2140 |
|
16 |
12 |
$597.54 |
| D1120 |
Prophylaxis - child |
24 |
12 |
$516.00 |