| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,658 |
5,460 |
$188K |
| D1999 |
|
7,006 |
5,996 |
$102K |
| D0330 |
Panoramic radiographic image |
2,940 |
2,454 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
6,056 |
4,882 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,580 |
3,009 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,460 |
3,604 |
$63K |
| D1120 |
Prophylaxis - child |
2,827 |
2,296 |
$52K |
| D0272 |
Bitewings - two radiographic images |
3,324 |
2,741 |
$49K |
| D2140 |
|
510 |
248 |
$15K |
| D1351 |
Sealant - per tooth |
802 |
104 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
219 |
136 |
$8K |
| D2160 |
|
140 |
88 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
158 |
157 |
$6K |
| D2940 |
|
199 |
137 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
40 |
$2K |
| D2335 |
|
22 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
195 |
163 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
12 |
$95.40 |