| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,545 |
3,541 |
$151K |
| D0330 |
Panoramic radiographic image |
2,237 |
2,224 |
$140K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,793 |
917 |
$136K |
| D2140 |
|
2,362 |
1,088 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
4,957 |
4,947 |
$129K |
| D1206 |
Topical application of fluoride varnish |
4,227 |
4,213 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,836 |
2,831 |
$88K |
| D1120 |
Prophylaxis - child |
2,737 |
2,734 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,969 |
1,965 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
2,252 |
2,219 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
722 |
460 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,196 |
4,085 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,556 |
3,277 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,265 |
1,265 |
$35K |
| D1330 |
|
892 |
890 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
164 |
114 |
$18K |
| D1351 |
Sealant - per tooth |
424 |
90 |
$13K |