| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,725 |
1,659 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,505 |
2,412 |
$57K |
| D0330 |
Panoramic radiographic image |
1,327 |
1,266 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,257 |
626 |
$42K |
| D1120 |
Prophylaxis - child |
749 |
725 |
$31K |
| D0274 |
Bitewings - four radiographic images |
905 |
867 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
677 |
634 |
$19K |
| D2140 |
|
290 |
217 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
640 |
618 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
166 |
133 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
872 |
822 |
$6K |
| D0272 |
Bitewings - two radiographic images |
158 |
148 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
26 |
$193.70 |