| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,815 |
2,554 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
816 |
775 |
$17K |
| D1999 |
|
816 |
789 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
703 |
665 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
551 |
501 |
$7K |
| D0272 |
Bitewings - two radiographic images |
436 |
399 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
965 |
750 |
$6K |
| D0330 |
Panoramic radiographic image |
144 |
136 |
$4K |
| D1120 |
Prophylaxis - child |
201 |
184 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
237 |
226 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
411 |
372 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
102 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
38 |
$1K |
| D2140 |
|
19 |
14 |
$360.80 |
| D2940 |
|
15 |
15 |
$215.00 |