| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,966 |
2,562 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,117 |
968 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,516 |
1,320 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,772 |
1,501 |
$21K |
| D1999 |
|
1,579 |
1,352 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
552 |
342 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
609 |
419 |
$18K |
| D2330 |
|
315 |
124 |
$10K |
| D0272 |
Bitewings - two radiographic images |
704 |
598 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
506 |
411 |
$7K |
| D2140 |
|
241 |
160 |
$5K |
| D1120 |
Prophylaxis - child |
268 |
220 |
$4K |
| D0330 |
Panoramic radiographic image |
132 |
125 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
317 |
173 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
538 |
202 |
$2K |
| D2335 |
|
41 |
28 |
$2K |
| D1351 |
Sealant - per tooth |
105 |
12 |
$1K |
| D2160 |
|
38 |
37 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
38 |
$311.40 |