| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,551 |
8,735 |
$278K |
| D1999 |
|
10,475 |
8,181 |
$156K |
| D0330 |
Panoramic radiographic image |
5,210 |
4,438 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
9,037 |
7,367 |
$124K |
| D0272 |
Bitewings - two radiographic images |
8,092 |
6,804 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,071 |
3,561 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,504 |
913 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,252 |
3,556 |
$59K |
| D1120 |
Prophylaxis - child |
2,200 |
1,860 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
352 |
254 |
$13K |
| D1351 |
Sealant - per tooth |
579 |
81 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
819 |
764 |
$6K |
| D2140 |
|
154 |
96 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
573 |
518 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
76 |
$690.95 |