| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,944 |
1,834 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,504 |
2,383 |
$52K |
| D0274 |
Bitewings - four radiographic images |
896 |
851 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,217 |
1,156 |
$24K |
| D1120 |
Prophylaxis - child |
514 |
508 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
144 |
103 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
264 |
241 |
$8K |
| D2140 |
|
100 |
62 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
94 |
94 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
25 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$748.44 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$570.63 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
25 |
$170.94 |