| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,923 |
5,160 |
$150K |
| D7230 |
|
1,155 |
463 |
$149K |
| D0330 |
Panoramic radiographic image |
5,160 |
4,406 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,409 |
3,859 |
$85K |
| D0272 |
Bitewings - two radiographic images |
6,392 |
5,572 |
$83K |
| D1999 |
|
5,259 |
4,566 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,375 |
2,835 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
3,355 |
2,832 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
616 |
380 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
2,944 |
2,357 |
$34K |
| D1120 |
Prophylaxis - child |
1,650 |
1,357 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
6,009 |
5,195 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,817 |
5,524 |
$19K |
| D2140 |
|
718 |
293 |
$17K |
| D2160 |
|
471 |
218 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
510 |
212 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
503 |
242 |
$12K |
| D9110 |
|
735 |
509 |
$7K |
| D7250 |
|
105 |
74 |
$5K |
| D0350 |
|
1,515 |
1,327 |
$5K |
| D2161 |
|
36 |
22 |
$1K |
| D2330 |
|
90 |
27 |
$292.50 |