| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,455 |
2,711 |
$94K |
| D1999 |
|
5,112 |
4,104 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
3,888 |
3,057 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,389 |
1,931 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,674 |
2,020 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,278 |
1,670 |
$32K |
| D1120 |
Prophylaxis - child |
1,506 |
1,156 |
$29K |
| D2140 |
|
836 |
362 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,008 |
756 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,241 |
1,837 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
471 |
263 |
$15K |
| D0330 |
Panoramic radiographic image |
356 |
216 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
43 |
$1K |
| D2160 |
|
18 |
15 |
$621.62 |
| D2335 |
|
23 |
12 |
$608.81 |
| D2330 |
|
21 |
12 |
$462.98 |
| D2940 |
|
13 |
12 |
$232.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$125.90 |