| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,971 |
3,302 |
$103K |
| D0330 |
Panoramic radiographic image |
2,125 |
1,793 |
$56K |
| D1999 |
|
3,332 |
2,819 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,536 |
2,062 |
$45K |
| D0272 |
Bitewings - two radiographic images |
3,213 |
2,663 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,803 |
1,535 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
899 |
708 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
248 |
173 |
$8K |
| D1120 |
Prophylaxis - child |
368 |
281 |
$6K |
| D2140 |
|
148 |
84 |
$3K |
| D1351 |
Sealant - per tooth |
184 |
25 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
28 |
$1K |
| D2331 |
|
25 |
12 |
$985.60 |
| D2335 |
|
19 |
13 |
$715.23 |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
95 |
$621.89 |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
15 |
$531.92 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$127.40 |