| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,989 |
4,306 |
$133K |
| D1999 |
|
6,477 |
5,617 |
$98K |
| D0330 |
Panoramic radiographic image |
2,441 |
2,096 |
$70K |
| D0272 |
Bitewings - two radiographic images |
3,747 |
3,249 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
3,370 |
2,886 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,164 |
1,858 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,223 |
1,144 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,425 |
1,140 |
$20K |
| D2140 |
|
710 |
496 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,466 |
957 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
353 |
264 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
284 |
244 |
$8K |
| D1120 |
Prophylaxis - child |
392 |
280 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
835 |
803 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
28 |
$3K |
| D1351 |
Sealant - per tooth |
112 |
13 |
$2K |
| D2331 |
|
13 |
13 |
$383.04 |