| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,320 |
1,175 |
$31K |
| D0330 |
Panoramic radiographic image |
595 |
522 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
1,093 |
959 |
$11K |
| D0272 |
Bitewings - two radiographic images |
855 |
740 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
191 |
99 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
399 |
334 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
385 |
341 |
$5K |
| D1120 |
Prophylaxis - child |
271 |
235 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
104 |
68 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
337 |
290 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
327 |
268 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
24 |
$1K |
| D2140 |
|
27 |
15 |
$475.20 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$337.50 |
| D1999 |
|
219 |
207 |
$292.55 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
17 |
$193.50 |