| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,448 |
1,448 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
1,824 |
1,824 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,952 |
1,952 |
$32K |
| D0330 |
Panoramic radiographic image |
476 |
476 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,814 |
1,077 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,217 |
1,213 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
107 |
$15K |
| D0272 |
Bitewings - two radiographic images |
741 |
741 |
$13K |
| D0274 |
Bitewings - four radiographic images |
483 |
483 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
264 |
264 |
$10K |
| D1120 |
Prophylaxis - child |
238 |
238 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
14 |
$2K |