| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,209 |
4,506 |
$138K |
| D0330 |
Panoramic radiographic image |
2,702 |
2,305 |
$77K |
| D1999 |
|
5,202 |
4,481 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,141 |
2,678 |
$59K |
| D0272 |
Bitewings - two radiographic images |
4,099 |
3,565 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
3,313 |
2,913 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,081 |
1,762 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
804 |
450 |
$24K |
| D1120 |
Prophylaxis - child |
972 |
818 |
$17K |
| D2160 |
|
361 |
248 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,615 |
1,458 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,557 |
1,319 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
290 |
153 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
560 |
450 |
$7K |
| D2140 |
|
241 |
137 |
$6K |
| D2335 |
|
31 |
14 |
$2K |
| D2161 |
|
35 |
27 |
$2K |
| D2940 |
|
85 |
48 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
14 |
$561.60 |