| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,262 |
3,835 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
3,865 |
3,502 |
$49K |
| D0330 |
Panoramic radiographic image |
1,730 |
1,541 |
$47K |
| D1999 |
|
2,789 |
2,587 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,565 |
2,300 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,482 |
1,295 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,763 |
1,588 |
$24K |
| D1120 |
Prophylaxis - child |
833 |
732 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
271 |
184 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
202 |
118 |
$6K |
| D2140 |
|
158 |
81 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
161 |
136 |
$790.15 |
| D2330 |
|
17 |
12 |
$545.62 |
| D0140 |
Limited oral evaluation - problem focused |
33 |
33 |
$357.21 |
| D2940 |
|
18 |
13 |
$227.50 |