| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,567 |
1,378 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,560 |
1,383 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,511 |
1,348 |
$21K |
| D1999 |
|
933 |
845 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
602 |
496 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,184 |
1,028 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,279 |
1,023 |
$7K |
| D0330 |
Panoramic radiographic image |
184 |
183 |
$6K |
| D1120 |
Prophylaxis - child |
189 |
149 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
236 |
190 |
$3K |
| D2335 |
|
33 |
26 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
39 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
26 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$821.05 |
| D2330 |
|
36 |
12 |
$819.00 |
| D9995 |
|
17 |
17 |
$210.00 |