| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,398 |
4,011 |
$149K |
| D0274 |
Bitewings - four radiographic images |
3,869 |
3,491 |
$92K |
| D0330 |
Panoramic radiographic image |
2,184 |
1,950 |
$81K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
927 |
443 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,103 |
653 |
$66K |
| D1206 |
Topical application of fluoride varnish |
3,209 |
2,939 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
3,284 |
2,996 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
803 |
472 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,429 |
1,253 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,079 |
963 |
$24K |
| D2140 |
|
473 |
278 |
$15K |
| D2950 |
|
133 |
100 |
$13K |
| D2330 |
|
195 |
114 |
$8K |
| D9110 |
|
59 |
54 |
$2K |
| D1120 |
Prophylaxis - child |
35 |
28 |
$1K |
| D0460 |
|
2,767 |
1,287 |
$1K |
| D2951 |
|
17 |
12 |
$168.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$120.00 |
| D0603 |
|
2,315 |
2,091 |
$0.05 |