| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
18,401 |
16,902 |
$483K |
| D0120 |
Periodic oral evaluation - established patient |
20,820 |
19,047 |
$284K |
| D1999 |
|
18,709 |
17,447 |
$279K |
| D0272 |
Bitewings - two radiographic images |
12,825 |
11,772 |
$185K |
| D0330 |
Panoramic radiographic image |
6,303 |
5,768 |
$181K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,694 |
7,885 |
$122K |
| D1120 |
Prophylaxis - child |
5,333 |
4,830 |
$98K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,358 |
1,824 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,282 |
2,089 |
$46K |
| D2140 |
|
1,196 |
996 |
$36K |
| D2160 |
|
405 |
343 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
307 |
239 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
116 |
$2K |
| D2335 |
|
37 |
26 |
$2K |
| D2331 |
|
44 |
26 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
12 |
12 |
$421.20 |
| D2330 |
|
16 |
14 |
$347.00 |