| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,176 |
4,750 |
$144K |
| D1999 |
|
8,706 |
7,782 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
4,417 |
4,013 |
$65K |
| D0330 |
Panoramic radiographic image |
1,947 |
1,784 |
$58K |
| D0272 |
Bitewings - two radiographic images |
3,860 |
3,563 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,051 |
747 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,885 |
1,762 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,112 |
1,947 |
$29K |
| D2160 |
|
522 |
409 |
$28K |
| D1120 |
Prophylaxis - child |
988 |
907 |
$19K |
| D2140 |
|
235 |
180 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
65 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
675 |
591 |
$5K |
| D2335 |
|
34 |
25 |
$3K |
| D1351 |
Sealant - per tooth |
121 |
19 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
33 |
$618.42 |