| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,679 |
1,514 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,199 |
2,000 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,129 |
1,028 |
$26K |
| D1120 |
Prophylaxis - child |
206 |
176 |
$8K |
| D0330 |
Panoramic radiographic image |
228 |
206 |
$7K |
| D1206 |
Topical application of fluoride varnish |
481 |
436 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
44 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
106 |
87 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$528.20 |
| D0220 |
Intraoral - periapical first radiographic image |
33 |
30 |
$238.80 |
| D1999 |
|
226 |
178 |
$0.00 |