| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,485 |
4,738 |
$144K |
| D0210 |
Intraoral - complete series of radiographic images |
2,307 |
2,013 |
$95K |
| D1999 |
|
5,386 |
4,427 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,251 |
2,839 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,429 |
962 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
4,059 |
3,468 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,451 |
2,086 |
$33K |
| D1120 |
Prophylaxis - child |
907 |
766 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
165 |
118 |
$4K |
| D0272 |
Bitewings - two radiographic images |
165 |
136 |
$2K |
| D2140 |
|
76 |
39 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
51 |
$1K |
| D2160 |
|
27 |
24 |
$730.90 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$480.00 |