| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,274 |
5,587 |
$162K |
| D0330 |
Panoramic radiographic image |
4,113 |
3,486 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
5,900 |
5,280 |
$73K |
| D0272 |
Bitewings - two radiographic images |
4,383 |
3,823 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,209 |
2,764 |
$44K |
| D1351 |
Sealant - per tooth |
2,444 |
286 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,778 |
1,459 |
$32K |
| D1120 |
Prophylaxis - child |
1,794 |
1,537 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
806 |
417 |
$23K |
| D2160 |
|
545 |
360 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
337 |
223 |
$17K |
| D2335 |
|
253 |
112 |
$13K |
| D1999 |
|
520 |
504 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
830 |
775 |
$5K |
| D2140 |
|
206 |
113 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
820 |
518 |
$5K |
| D2940 |
|
78 |
42 |
$2K |
| D2330 |
|
47 |
25 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
13 |
$1K |