| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,133 |
4,355 |
$143K |
| D0330 |
Panoramic radiographic image |
3,176 |
2,713 |
$93K |
| D1999 |
|
5,902 |
5,161 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
5,235 |
4,343 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,570 |
2,275 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,381 |
2,797 |
$47K |
| D1120 |
Prophylaxis - child |
1,887 |
1,565 |
$34K |
| D2160 |
|
436 |
341 |
$18K |
| D2140 |
|
625 |
383 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
533 |
325 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
178 |
142 |
$14K |
| D2161 |
|
70 |
63 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
155 |
105 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
98 |
$2K |
| D2335 |
|
22 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
93 |
67 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
25 |
$120.70 |