| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,474 |
3,387 |
$161K |
| D1110 |
Prophylaxis - adult |
3,743 |
3,674 |
$144K |
| D5211 |
|
253 |
240 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,373 |
3,317 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,991 |
1,942 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
3,844 |
3,730 |
$57K |
| D5212 |
|
95 |
89 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,405 |
1,367 |
$32K |
| D5110 |
|
88 |
84 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,371 |
1,335 |
$24K |
| D1206 |
Topical application of fluoride varnish |
593 |
540 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,613 |
1,526 |
$19K |
| D2140 |
|
302 |
153 |
$10K |
| D1120 |
Prophylaxis - child |
219 |
196 |
$9K |
| D5120 |
|
13 |
13 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
14 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
31 |
26 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
13 |
$1K |
| D9310 |
|
28 |
28 |
$687.49 |