| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,183 |
3,159 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,391 |
853 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,088 |
578 |
$42K |
| D1110 |
Prophylaxis - adult |
1,486 |
1,482 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,241 |
1,240 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,146 |
3,129 |
$23K |
| D2140 |
|
480 |
226 |
$15K |
| D4355 |
|
414 |
410 |
$14K |
| D1120 |
Prophylaxis - child |
1,161 |
1,160 |
$5K |
| D4341 |
|
268 |
86 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,757 |
1,754 |
$4K |
| D1330 |
|
2,726 |
2,718 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
709 |
707 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
1,078 |
799 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
15 |
$669.12 |
| D1351 |
Sealant - per tooth |
46 |
12 |
$604.39 |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
101 |
$227.70 |