| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,694 |
7,489 |
$226K |
| D1999 |
|
8,653 |
8,183 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
6,985 |
6,892 |
$99K |
| D0330 |
Panoramic radiographic image |
3,181 |
3,084 |
$98K |
| D0272 |
Bitewings - two radiographic images |
5,394 |
5,250 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,998 |
2,865 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,740 |
3,676 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,126 |
876 |
$43K |
| D1120 |
Prophylaxis - child |
2,210 |
2,179 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
958 |
775 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,485 |
1,464 |
$9K |
| D1351 |
Sealant - per tooth |
522 |
61 |
$8K |
| D2140 |
|
188 |
160 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
403 |
392 |
$2K |
| D2160 |
|
12 |
12 |
$413.08 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$165.37 |