| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,252 |
3,570 |
$117K |
| D0330 |
Panoramic radiographic image |
2,067 |
1,735 |
$61K |
| D1999 |
|
3,947 |
3,193 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
3,169 |
2,649 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,479 |
2,046 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,293 |
1,107 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
434 |
334 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
169 |
$3K |
| D2140 |
|
86 |
43 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
28 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
24 |
$1K |
| D2335 |
|
19 |
13 |
$894.91 |