| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
576 |
541 |
$19K |
| D0330 |
Panoramic radiographic image |
294 |
275 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
756 |
705 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
518 |
481 |
$8K |
| D1120 |
Prophylaxis - child |
388 |
355 |
$8K |
| D0274 |
Bitewings - four radiographic images |
381 |
350 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
173 |
29 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
256 |
231 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
192 |
173 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
79 |
44 |
$4K |
| D2140 |
|
58 |
30 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
227 |
184 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
27 |
$283.50 |