| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,403 |
1,267 |
$42K |
| D1999 |
|
2,610 |
2,318 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
758 |
693 |
$17K |
| D0330 |
Panoramic radiographic image |
488 |
445 |
$15K |
| D0272 |
Bitewings - two radiographic images |
926 |
852 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
294 |
187 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
450 |
422 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
64 |
$4K |
| D2140 |
|
42 |
28 |
$2K |
| D2160 |
|
17 |
14 |
$963.16 |
| D1208 |
Topical application of fluoride, excluding varnish |
62 |
60 |
$911.20 |
| D0220 |
Intraoral - periapical first radiographic image |
47 |
41 |
$326.87 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$259.72 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$214.40 |