| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,125 |
2,038 |
$89K |
| D2161 |
|
897 |
447 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
631 |
370 |
$66K |
| D1110 |
Prophylaxis - adult |
1,507 |
1,446 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,583 |
2,481 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,128 |
1,027 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,143 |
1,098 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
903 |
872 |
$18K |
| D1120 |
Prophylaxis - child |
95 |
88 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
424 |
403 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
102 |
96 |
$1K |