| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
4,619 |
4,376 |
$226K |
| D1110 |
Prophylaxis - adult |
3,937 |
3,825 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,745 |
4,495 |
$129K |
| D2161 |
|
1,292 |
689 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
2,924 |
2,866 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
936 |
294 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
776 |
408 |
$44K |
| D2160 |
|
600 |
373 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,501 |
1,423 |
$39K |
| D1120 |
Prophylaxis - child |
1,502 |
1,468 |
$32K |
| D2335 |
|
321 |
143 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,798 |
1,761 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,151 |
1,432 |
$26K |
| D1320 |
|
1,398 |
1,352 |
$22K |
| D0272 |
Bitewings - two radiographic images |
2,194 |
2,124 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,166 |
1,143 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,981 |
2,811 |
$17K |
| D2140 |
|
324 |
185 |
$15K |
| D1321 |
|
721 |
695 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
415 |
373 |
$7K |
| D1206 |
Topical application of fluoride varnish |
357 |
351 |
$6K |
| D2332 |
|
34 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
42 |
$1K |
| D1330 |
|
328 |
322 |
$0.00 |
| D9215 |
|
259 |
192 |
$0.00 |