| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,237 |
1,105 |
$32K |
| D1999 |
|
1,926 |
1,655 |
$26K |
| D0272 |
Bitewings - two radiographic images |
907 |
827 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
603 |
568 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,286 |
669 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
522 |
460 |
$6K |
| D0330 |
Panoramic radiographic image |
192 |
176 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
884 |
796 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
55 |
39 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
109 |
102 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
115 |
94 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
15 |
$700.07 |
| D2140 |
|
18 |
13 |
$388.80 |
| D1120 |
Prophylaxis - child |
28 |
22 |
$340.20 |