| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,210 |
3,114 |
$120K |
| D0330 |
Panoramic radiographic image |
1,587 |
1,543 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
4,264 |
4,156 |
$82K |
| D2335 |
|
719 |
233 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,561 |
3,431 |
$60K |
| D1120 |
Prophylaxis - child |
2,509 |
2,422 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,327 |
2,252 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,686 |
1,606 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,667 |
1,755 |
$41K |
| D1351 |
Sealant - per tooth |
1,532 |
338 |
$33K |
| D1321 |
|
1,176 |
1,161 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
859 |
822 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
368 |
158 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,876 |
1,786 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
52 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
16 |
$4K |
| D0272 |
Bitewings - two radiographic images |
286 |
274 |
$3K |