| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,011 |
3,382 |
$109K |
| D0330 |
Panoramic radiographic image |
2,797 |
2,336 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,494 |
805 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,240 |
1,874 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
3,058 |
2,594 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,772 |
1,433 |
$25K |
| D1999 |
|
1,310 |
1,230 |
$21K |
| D1120 |
Prophylaxis - child |
840 |
664 |
$14K |
| D0272 |
Bitewings - two radiographic images |
677 |
596 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
80 |
63 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
36 |
$2K |
| D7250 |
|
40 |
15 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
131 |
127 |
$699.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
16 |
$75.90 |