| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,502 |
6,416 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
8,018 |
6,866 |
$99K |
| D0330 |
Panoramic radiographic image |
3,531 |
2,973 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,219 |
1,344 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,899 |
1,277 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,696 |
3,005 |
$51K |
| D2140 |
|
1,820 |
1,194 |
$47K |
| D1999 |
|
2,341 |
2,127 |
$33K |
| D1120 |
Prophylaxis - child |
1,843 |
1,460 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,963 |
1,547 |
$30K |
| D2940 |
|
1,368 |
918 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,420 |
1,183 |
$17K |
| D2160 |
|
316 |
242 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
357 |
323 |
$4K |
| D2335 |
|
59 |
41 |
$2K |
| D2330 |
|
44 |
16 |
$959.00 |
| D2332 |
|
27 |
15 |
$851.00 |
| D0220 |
Intraoral - periapical first radiographic image |
154 |
148 |
$797.25 |