| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
965 |
911 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,066 |
1,007 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,066 |
999 |
$25K |
| D0274 |
Bitewings - four radiographic images |
983 |
909 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
392 |
212 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
406 |
149 |
$14K |
| D1110 |
Prophylaxis - adult |
297 |
274 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
120 |
53 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,028 |
971 |
$8K |
| D2332 |
|
74 |
40 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
303 |
278 |
$4K |
| D1120 |
Prophylaxis - child |
88 |
82 |
$4K |
| D2160 |
|
67 |
39 |
$3K |
| D2335 |
|
34 |
12 |
$2K |
| D2140 |
|
40 |
24 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
244 |
122 |
$1K |
| D1351 |
Sealant - per tooth |
43 |
15 |
$727.36 |