| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
2,355 |
551 |
$149K |
| D0330 |
Panoramic radiographic image |
1,619 |
1,490 |
$65K |
| D1110 |
Prophylaxis - adult |
1,566 |
1,421 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,963 |
1,783 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
333 |
170 |
$20K |
| D2394 |
|
297 |
176 |
$16K |
| D0274 |
Bitewings - four radiographic images |
554 |
472 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,006 |
837 |
$7K |
| D1120 |
Prophylaxis - child |
135 |
117 |
$5K |
| D9110 |
|
251 |
208 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
292 |
257 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
206 |
198 |
$4K |
| D2332 |
|
85 |
15 |
$3K |
| D1351 |
Sealant - per tooth |
207 |
35 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
53 |
$1K |
| D9986 |
|
117 |
94 |
$15.00 |