| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,619 |
3,574 |
$134K |
| D0330 |
Panoramic radiographic image |
1,339 |
1,310 |
$60K |
| D1206 |
Topical application of fluoride varnish |
3,719 |
3,666 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,104 |
2,071 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,988 |
2,956 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,933 |
1,889 |
$49K |
| D2740 |
Crown - porcelain/ceramic |
135 |
84 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,157 |
1,134 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,080 |
1,897 |
$21K |
| D2140 |
|
228 |
129 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
150 |
101 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
50 |
$5K |
| D1120 |
Prophylaxis - child |
171 |
169 |
$5K |
| D2331 |
|
16 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
72 |
$635.70 |