| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,972 |
4,406 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,919 |
1,364 |
$62K |
| D0330 |
Panoramic radiographic image |
2,023 |
1,783 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,857 |
2,465 |
$52K |
| D1999 |
|
3,052 |
2,880 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
3,419 |
3,015 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,891 |
1,577 |
$26K |
| D2140 |
|
614 |
264 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,005 |
864 |
$14K |
| D1120 |
Prophylaxis - child |
785 |
614 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
353 |
220 |
$10K |
| D1351 |
Sealant - per tooth |
243 |
33 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
120 |
$748.44 |
| D2332 |
|
23 |
12 |
$722.76 |