| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,958 |
5,006 |
$171K |
| D1999 |
|
7,354 |
6,309 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,296 |
3,659 |
$92K |
| D0330 |
Panoramic radiographic image |
2,479 |
2,140 |
$79K |
| D0272 |
Bitewings - two radiographic images |
4,663 |
3,992 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,829 |
3,276 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,067 |
683 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,507 |
2,076 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,728 |
1,485 |
$30K |
| D1120 |
Prophylaxis - child |
1,148 |
949 |
$22K |
| D2940 |
|
761 |
633 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
29 |
$2K |
| D2335 |
|
17 |
13 |
$1K |
| D2140 |
|
16 |
13 |
$630.22 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$98.41 |