| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,421 |
2,191 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
2,922 |
2,640 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,011 |
2,800 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,413 |
2,230 |
$54K |
| D1120 |
Prophylaxis - child |
833 |
779 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
722 |
611 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
248 |
57 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
192 |
152 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
815 |
707 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
299 |
225 |
$4K |
| D1206 |
Topical application of fluoride varnish |
188 |
137 |
$4K |
| D1351 |
Sealant - per tooth |
107 |
12 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
13 |
$2K |
| D2140 |
|
27 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$1K |
| D0602 |
|
151 |
139 |
$675.97 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$410.40 |
| D0601 |
|
51 |
46 |
$245.00 |
| D0603 |
|
12 |
12 |
$50.00 |