| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,057 |
2,576 |
$75K |
| D0330 |
Panoramic radiographic image |
1,892 |
1,607 |
$52K |
| D1999 |
|
2,425 |
2,212 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
3,109 |
2,586 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,410 |
2,012 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,538 |
1,307 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,156 |
1,775 |
$29K |
| D1120 |
Prophylaxis - child |
1,239 |
1,015 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
535 |
367 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
3,322 |
2,800 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
852 |
762 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
150 |
136 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,614 |
2,183 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
119 |
117 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
90 |
62 |
$3K |