| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,093 |
2,092 |
$111K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
331 |
292 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,395 |
2,394 |
$65K |
| D0330 |
Panoramic radiographic image |
1,627 |
1,625 |
$46K |
| D9243 |
|
324 |
322 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,501 |
1,501 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,183 |
1,182 |
$16K |
| D9239 |
|
276 |
275 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
856 |
856 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
705 |
704 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
784 |
784 |
$7K |
| D0274 |
Bitewings - four radiographic images |
271 |
271 |
$7K |
| D1120 |
Prophylaxis - child |
172 |
172 |
$7K |
| D1351 |
Sealant - per tooth |
64 |
40 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
62 |
46 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
185 |
$5K |
| D2335 |
|
19 |
12 |
$3K |
| D2140 |
|
15 |
12 |
$1K |
| D1999 |
|
41 |
41 |
$0.00 |