| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,672 |
5,400 |
$214K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,602 |
1,179 |
$175K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,800 |
4,540 |
$106K |
| D0330 |
Panoramic radiographic image |
2,269 |
2,112 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
4,999 |
4,770 |
$72K |
| D2394 |
|
756 |
597 |
$60K |
| D2335 |
|
692 |
468 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,694 |
2,575 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,658 |
1,499 |
$38K |
| D2954 |
|
247 |
203 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,628 |
2,284 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
923 |
854 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
281 |
144 |
$26K |
| D9110 |
|
438 |
396 |
$16K |
| D2161 |
|
198 |
171 |
$11K |
| D2332 |
|
104 |
67 |
$7K |
| D2160 |
|
108 |
85 |
$5K |
| D2140 |
|
159 |
97 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
52 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
96 |
72 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
16 |
$2K |
| D2330 |
|
48 |
28 |
$2K |
| D1120 |
Prophylaxis - child |
14 |
14 |
$546.78 |
| D0603 |
|
583 |
573 |
$2.48 |
| D0602 |
|
343 |
334 |
$2.31 |