| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
7,524 |
6,457 |
$116K |
| D1110 |
Prophylaxis - adult |
2,783 |
2,479 |
$74K |
| D0330 |
Panoramic radiographic image |
1,413 |
1,291 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,367 |
2,160 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
701 |
528 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
2,122 |
1,882 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,060 |
985 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
785 |
738 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
234 |
170 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
414 |
408 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,122 |
428 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
810 |
782 |
$6K |
| D1120 |
Prophylaxis - child |
240 |
226 |
$4K |
| D2140 |
|
118 |
83 |
$4K |
| D2160 |
|
34 |
25 |
$2K |
| D9996 |
|
14 |
13 |
$196.00 |