| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
9,170 |
7,437 |
$264K |
| D1999 |
|
15,227 |
12,000 |
$215K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,774 |
4,078 |
$112K |
| D0330 |
Panoramic radiographic image |
3,481 |
3,011 |
$107K |
| D0272 |
Bitewings - two radiographic images |
6,889 |
5,678 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
6,443 |
4,956 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,574 |
2,585 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,600 |
2,838 |
$52K |
| D1120 |
Prophylaxis - child |
2,200 |
1,731 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,263 |
2,527 |
$27K |
| D2335 |
|
171 |
75 |
$13K |
| D0160 |
|
325 |
324 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
114 |
73 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
165 |
83 |
$8K |
| D1351 |
Sealant - per tooth |
294 |
53 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
58 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
15 |
$2K |