| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,276 |
5,099 |
$203K |
| D2954 |
|
826 |
567 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
5,692 |
5,447 |
$87K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,471 |
641 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,467 |
2,375 |
$64K |
| D0330 |
Panoramic radiographic image |
1,353 |
1,294 |
$64K |
| D3310 |
|
140 |
79 |
$45K |
| D5212 |
|
112 |
106 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,404 |
1,339 |
$39K |
| D2750 |
|
51 |
30 |
$29K |
| D2950 |
|
194 |
139 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
865 |
785 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,990 |
1,900 |
$23K |
| D5211 |
|
53 |
50 |
$18K |
| D2140 |
|
345 |
164 |
$17K |
| D2160 |
|
241 |
170 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
342 |
329 |
$13K |
| D1120 |
Prophylaxis - child |
256 |
213 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
218 |
78 |
$9K |
| D2332 |
|
143 |
41 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
318 |
301 |
$6K |
| D5110 |
|
13 |
13 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
442 |
277 |
$3K |
| D2331 |
|
38 |
15 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
13 |
$2K |