| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,283 |
6,862 |
$328K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,708 |
479 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
10,193 |
9,559 |
$214K |
| D1120 |
Prophylaxis - child |
4,162 |
3,866 |
$120K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,651 |
886 |
$115K |
| D0274 |
Bitewings - four radiographic images |
3,590 |
3,380 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,275 |
5,840 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,783 |
2,602 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
2,503 |
2,315 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,518 |
1,368 |
$86K |
| D0330 |
Panoramic radiographic image |
1,560 |
1,441 |
$85K |
| D1351 |
Sealant - per tooth |
3,631 |
584 |
$76K |
| D0240 |
|
3,765 |
2,230 |
$72K |
| D2140 |
|
1,151 |
556 |
$52K |
| D1206 |
Topical application of fluoride varnish |
1,575 |
1,475 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,543 |
1,426 |
$31K |
| D2332 |
|
268 |
155 |
$27K |
| D2160 |
|
265 |
158 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
485 |
148 |
$24K |
| D5110 |
|
46 |
40 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,765 |
1,595 |
$20K |
| D5120 |
|
16 |
12 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
407 |
376 |
$5K |