| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,134 |
2,098 |
$97K |
| D0330 |
Panoramic radiographic image |
2,302 |
2,261 |
$94K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
778 |
412 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,830 |
1,796 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,093 |
2,054 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,154 |
1,133 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,523 |
1,495 |
$33K |
| D1120 |
Prophylaxis - child |
583 |
572 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
612 |
405 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,132 |
1,110 |
$16K |
| D1351 |
Sealant - per tooth |
414 |
91 |
$8K |
| D2140 |
|
201 |
137 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
40 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
856 |
822 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
58 |
$5K |
| D0272 |
Bitewings - two radiographic images |
297 |
287 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
41 |
$3K |
| D4341 |
|
38 |
16 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
114 |
112 |
$2K |
| D9986 |
|
1,534 |
1,407 |
$966.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
47 |
38 |
$313.17 |