| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,046 |
1,788 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
850 |
433 |
$28K |
| D1999 |
|
2,001 |
1,778 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
938 |
795 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,263 |
1,080 |
$16K |
| D0330 |
Panoramic radiographic image |
265 |
234 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
543 |
445 |
$8K |
| D2940 |
|
320 |
228 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
389 |
352 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
167 |
107 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
542 |
481 |
$3K |
| D1120 |
Prophylaxis - child |
165 |
146 |
$3K |
| D0272 |
Bitewings - two radiographic images |
164 |
144 |
$2K |
| D2335 |
|
29 |
12 |
$2K |
| D2140 |
|
100 |
56 |
$2K |
| D2160 |
|
14 |
13 |
$423.90 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
13 |
$88.20 |