| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,289 |
6,875 |
$181K |
| D0330 |
Panoramic radiographic image |
3,486 |
3,287 |
$94K |
| D1999 |
|
5,339 |
5,092 |
$81K |
| D0272 |
Bitewings - two radiographic images |
5,293 |
4,976 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
5,357 |
4,998 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,516 |
2,389 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,489 |
1,362 |
$20K |
| D1120 |
Prophylaxis - child |
450 |
389 |
$7K |
| D2140 |
|
170 |
96 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
269 |
239 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
76 |
59 |
$2K |
| D2335 |
|
24 |
16 |
$641.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
12 |
$540.00 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
12 |
$64.80 |