| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,361 |
3,272 |
$137K |
| D0330 |
Panoramic radiographic image |
2,178 |
2,126 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,816 |
2,747 |
$89K |
| D1351 |
Sealant - per tooth |
2,863 |
584 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
620 |
619 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
1,654 |
1,631 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,743 |
1,720 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,186 |
1,170 |
$29K |
| D1120 |
Prophylaxis - child |
916 |
908 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
253 |
80 |
$21K |
| D2140 |
|
390 |
232 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
287 |
178 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
120 |
117 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
332 |
325 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
250 |
106 |
$2K |
| D2330 |
|
20 |
12 |
$1K |
| D1320 |
|
35 |
35 |
$741.68 |