| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,222 |
7,020 |
$190K |
| D0330 |
Panoramic radiographic image |
3,254 |
3,160 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
6,114 |
5,918 |
$83K |
| D0272 |
Bitewings - two radiographic images |
5,531 |
5,355 |
$80K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,357 |
1,007 |
$52K |
| D1999 |
|
3,238 |
3,123 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,214 |
2,143 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,464 |
2,372 |
$34K |
| D1120 |
Prophylaxis - child |
1,129 |
1,077 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
279 |
192 |
$7K |
| D2335 |
|
147 |
88 |
$7K |
| D2160 |
|
112 |
95 |
$5K |
| D2140 |
|
123 |
89 |
$3K |
| D1351 |
Sealant - per tooth |
231 |
26 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
48 |
47 |
$629.37 |
| D2331 |
|
26 |
12 |
$553.00 |
| D0220 |
Intraoral - periapical first radiographic image |
91 |
90 |
$542.52 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
15 |
$432.00 |