| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,525 |
5,471 |
$161K |
| D0272 |
Bitewings - two radiographic images |
5,859 |
4,808 |
$76K |
| D0330 |
Panoramic radiographic image |
2,966 |
2,433 |
$75K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,315 |
1,399 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,969 |
1,188 |
$65K |
| D1999 |
|
4,695 |
4,210 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
5,133 |
4,243 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,618 |
2,992 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,010 |
2,396 |
$38K |
| D2160 |
|
850 |
592 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
5,107 |
4,179 |
$31K |
| D1120 |
Prophylaxis - child |
1,435 |
1,076 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,580 |
2,726 |
$21K |
| D2140 |
|
684 |
440 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,001 |
811 |
$13K |
| D2335 |
|
85 |
56 |
$3K |
| D2330 |
|
114 |
53 |
$3K |
| D2161 |
|
54 |
48 |
$2K |
| D2331 |
|
29 |
13 |
$774.42 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$505.10 |
| D2940 |
|
25 |
15 |
$440.00 |
| D3221 |
|
20 |
12 |
$314.00 |