| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,283 |
4,990 |
$141K |
| D0330 |
Panoramic radiographic image |
3,530 |
3,295 |
$101K |
| D1999 |
|
6,418 |
6,005 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,565 |
3,341 |
$74K |
| D0272 |
Bitewings - two radiographic images |
4,794 |
4,505 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,418 |
3,216 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
436 |
356 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,921 |
1,797 |
$27K |
| D1120 |
Prophylaxis - child |
621 |
567 |
$11K |
| D1351 |
Sealant - per tooth |
377 |
26 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
106 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
57 |
41 |
$2K |
| D2140 |
|
29 |
13 |
$891.91 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
13 |
$874.80 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$479.25 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$75.60 |