| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,939 |
4,451 |
$184K |
| D1999 |
|
8,911 |
6,821 |
$130K |
| D0330 |
Panoramic radiographic image |
3,566 |
2,676 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,437 |
3,287 |
$105K |
| D0272 |
Bitewings - two radiographic images |
4,358 |
3,251 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
669 |
454 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,566 |
1,234 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
243 |
192 |
$20K |
| D2160 |
|
225 |
173 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
546 |
388 |
$11K |
| D2140 |
|
258 |
166 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
41 |
$4K |
| D1120 |
Prophylaxis - child |
101 |
93 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
137 |
129 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
101 |
$879.42 |