| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,824 |
2,286 |
$66K |
| D0330 |
Panoramic radiographic image |
1,331 |
1,099 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,136 |
1,745 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
2,556 |
2,057 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
782 |
469 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
791 |
447 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,297 |
1,051 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
928 |
746 |
$13K |
| D1120 |
Prophylaxis - child |
781 |
631 |
$12K |
| D2160 |
|
357 |
263 |
$11K |
| D2140 |
|
412 |
244 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
835 |
655 |
$4K |
| D2331 |
|
126 |
61 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
810 |
645 |
$3K |
| D1351 |
Sealant - per tooth |
133 |
26 |
$2K |
| D1999 |
|
128 |
114 |
$1K |
| D2330 |
|
41 |
17 |
$942.50 |
| D2161 |
|
17 |
13 |
$611.00 |
| D2332 |
|
16 |
14 |
$563.50 |