| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,602 |
6,671 |
$210K |
| D1999 |
|
8,956 |
7,822 |
$133K |
| D0330 |
Panoramic radiographic image |
4,004 |
3,455 |
$117K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,805 |
1,677 |
$113K |
| D2140 |
|
2,914 |
1,525 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
6,033 |
5,289 |
$82K |
| D0272 |
Bitewings - two radiographic images |
5,603 |
4,918 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,081 |
2,681 |
$63K |
| D2160 |
|
1,111 |
702 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,800 |
1,759 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,951 |
2,532 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
493 |
410 |
$30K |
| D2335 |
|
418 |
140 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,233 |
1,101 |
$22K |
| D1120 |
Prophylaxis - child |
1,132 |
963 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,895 |
1,739 |
$11K |
| D1351 |
Sealant - per tooth |
175 |
14 |
$3K |
| D2161 |
|
16 |
12 |
$882.90 |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
14 |
$470.50 |
| D3120 |
|
61 |
29 |
$451.60 |