| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,073 |
3,652 |
$111K |
| D1999 |
|
4,576 |
3,952 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
3,347 |
2,978 |
$46K |
| D0330 |
Panoramic radiographic image |
1,557 |
1,419 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,949 |
2,670 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,408 |
1,309 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,449 |
1,329 |
$20K |
| D1120 |
Prophylaxis - child |
678 |
627 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
370 |
228 |
$11K |
| D2140 |
|
110 |
68 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
47 |
$2K |
| D2160 |
|
65 |
55 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
512 |
343 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
270 |
261 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$171.00 |