| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,582 |
5,289 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
4,319 |
4,119 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,769 |
2,553 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
463 |
361 |
$46K |
| D0272 |
Bitewings - two radiographic images |
3,337 |
3,102 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,624 |
3,685 |
$37K |
| D1999 |
|
2,166 |
2,077 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
809 |
493 |
$32K |
| D2140 |
|
1,013 |
482 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
3,759 |
3,501 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,941 |
1,800 |
$26K |
| D0330 |
Panoramic radiographic image |
783 |
764 |
$23K |
| D1120 |
Prophylaxis - child |
1,151 |
1,059 |
$20K |
| D1351 |
Sealant - per tooth |
282 |
40 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
38 |
$2K |