| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,942 |
5,851 |
$182K |
| D1999 |
|
9,092 |
6,976 |
$134K |
| D0330 |
Panoramic radiographic image |
3,613 |
3,112 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
6,836 |
5,672 |
$95K |
| D0272 |
Bitewings - two radiographic images |
5,671 |
4,798 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,689 |
3,114 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,511 |
2,214 |
$50K |
| D1120 |
Prophylaxis - child |
2,338 |
1,984 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
170 |
113 |
$19K |
| D2140 |
|
587 |
430 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
461 |
327 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
556 |
388 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
251 |
219 |
$3K |
| D2160 |
|
13 |
12 |
$359.80 |
| D0220 |
Intraoral - periapical first radiographic image |
62 |
58 |
$275.40 |