| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,574 |
1,381 |
$42K |
| D0330 |
Panoramic radiographic image |
807 |
693 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,213 |
1,066 |
$15K |
| D1999 |
|
783 |
741 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
457 |
233 |
$12K |
| D2140 |
|
502 |
224 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
553 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
846 |
722 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
77 |
47 |
$6K |
| D7250 |
|
104 |
63 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
271 |
226 |
$4K |
| D2330 |
|
160 |
62 |
$4K |
| D2160 |
|
109 |
67 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
232 |
196 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
371 |
309 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
431 |
123 |
$2K |
| D2335 |
|
24 |
14 |
$947.50 |
| D1120 |
Prophylaxis - child |
21 |
12 |
$340.20 |