| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,905 |
1,903 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
2,524 |
2,124 |
$88K |
| D0330 |
Panoramic radiographic image |
893 |
891 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,592 |
1,588 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
690 |
325 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,501 |
1,499 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,111 |
1,109 |
$42K |
| D2160 |
|
174 |
106 |
$18K |
| D9110 |
|
408 |
374 |
$18K |
| D1120 |
Prophylaxis - child |
355 |
354 |
$13K |
| D1351 |
Sealant - per tooth |
340 |
72 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
106 |
25 |
$11K |
| D5212 |
|
12 |
12 |
$10K |
| D5211 |
|
12 |
12 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
575 |
566 |
$8K |
| D1206 |
Topical application of fluoride varnish |
246 |
245 |
$7K |
| D0272 |
Bitewings - two radiographic images |
68 |
67 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
32 |
$377.62 |