| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,406 |
8,312 |
$339K |
| D0330 |
Panoramic radiographic image |
2,990 |
2,934 |
$140K |
| D0274 |
Bitewings - four radiographic images |
3,887 |
3,841 |
$109K |
| D2954 |
|
699 |
551 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,385 |
632 |
$93K |
| D1206 |
Topical application of fluoride varnish |
1,761 |
1,679 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,820 |
1,783 |
$50K |
| D1120 |
Prophylaxis - child |
996 |
922 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,662 |
1,642 |
$27K |
| D3310 |
|
97 |
85 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
272 |
182 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
17 |
$9K |
| D5212 |
|
40 |
40 |
$9K |
| D5211 |
|
27 |
27 |
$6K |
| D1330 |
|
273 |
219 |
$5K |
| D2932 |
|
57 |
37 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
175 |
143 |
$5K |
| D5110 |
|
12 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
215 |
186 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
55 |
$630.00 |