| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,514 |
2,288 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,160 |
1,962 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,791 |
1,653 |
$26K |
| D1999 |
|
780 |
715 |
$14K |
| D0330 |
Panoramic radiographic image |
422 |
368 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
574 |
539 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
809 |
743 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
38 |
$5K |
| D1120 |
Prophylaxis - child |
186 |
186 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$810.42 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
13 |
$634.14 |
| D0220 |
Intraoral - periapical first radiographic image |
66 |
63 |
$533.20 |