| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,442 |
2,226 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,211 |
2,955 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,541 |
1,409 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,092 |
982 |
$32K |
| D1120 |
Prophylaxis - child |
909 |
826 |
$18K |
| D1206 |
Topical application of fluoride varnish |
825 |
797 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,424 |
1,154 |
$10K |
| D0330 |
Panoramic radiographic image |
263 |
223 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
709 |
606 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
208 |
91 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
315 |
267 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
77 |
41 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
15 |
12 |
$329.97 |
| D0601 |
|
99 |
92 |
$0.00 |