| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,938 |
3,022 |
$105K |
| D0330 |
Panoramic radiographic image |
2,027 |
1,549 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,749 |
2,075 |
$53K |
| D1999 |
|
3,210 |
2,438 |
$46K |
| D0272 |
Bitewings - two radiographic images |
3,067 |
2,308 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,043 |
670 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
2,206 |
1,737 |
$27K |
| D2140 |
|
796 |
381 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,255 |
907 |
$17K |
| D1120 |
Prophylaxis - child |
719 |
545 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,822 |
1,397 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
438 |
378 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
237 |
174 |
$6K |
| D7240 |
Removal of impacted tooth - completely bony |
14 |
12 |
$3K |
| D7220 |
|
15 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
467 |
172 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
15 |
$1K |