| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,701 |
6,751 |
$205K |
| D0330 |
Panoramic radiographic image |
4,862 |
4,204 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,188 |
5,270 |
$115K |
| D0272 |
Bitewings - two radiographic images |
5,568 |
4,851 |
$79K |
| D1999 |
|
4,763 |
4,491 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
3,697 |
3,213 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,706 |
2,152 |
$38K |
| D1351 |
Sealant - per tooth |
2,583 |
230 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,945 |
1,686 |
$32K |
| D1120 |
Prophylaxis - child |
1,620 |
1,203 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,898 |
1,604 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
250 |
130 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
201 |
90 |
$7K |
| D2140 |
|
102 |
60 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
356 |
252 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
95 |
66 |
$2K |