| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,562 |
3,399 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
5,366 |
4,974 |
$87K |
| D1206 |
Topical application of fluoride varnish |
5,619 |
5,104 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,017 |
585 |
$53K |
| D1120 |
Prophylaxis - child |
2,377 |
2,073 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,469 |
2,308 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,646 |
2,462 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
801 |
698 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
591 |
565 |
$14K |
| D0330 |
Panoramic radiographic image |
592 |
538 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,998 |
1,130 |
$14K |
| D2140 |
|
163 |
90 |
$6K |
| D0272 |
Bitewings - two radiographic images |
412 |
348 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
42 |
$5K |
| D2160 |
|
83 |
63 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
54 |
$2K |
| D9110 |
|
23 |
12 |
$67.95 |