| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,396 |
2,954 |
$89K |
| D1999 |
|
4,789 |
3,999 |
$71K |
| D0330 |
Panoramic radiographic image |
1,711 |
1,481 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,256 |
1,977 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,814 |
2,421 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,960 |
1,654 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
790 |
477 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,044 |
893 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
211 |
113 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
367 |
230 |
$10K |
| D1120 |
Prophylaxis - child |
500 |
416 |
$8K |
| D2160 |
|
214 |
148 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,071 |
869 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
377 |
323 |
$4K |
| D2140 |
|
138 |
98 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
683 |
513 |
$3K |
| D2940 |
|
75 |
53 |
$2K |
| D2335 |
|
43 |
17 |
$1K |
| D2161 |
|
36 |
25 |
$1K |