| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,267 |
3,267 |
$164K |
| D0330 |
Panoramic radiographic image |
1,769 |
1,769 |
$88K |
| D0272 |
Bitewings - two radiographic images |
3,209 |
3,209 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,635 |
2,635 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,355 |
1,347 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,026 |
1,026 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
419 |
334 |
$37K |
| D2140 |
|
516 |
407 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
271 |
244 |
$21K |
| D1120 |
Prophylaxis - child |
404 |
404 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
983 |
970 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
622 |
622 |
$10K |