| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,884 |
2,695 |
$84K |
| D1999 |
|
3,584 |
3,285 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,317 |
2,224 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,248 |
1,094 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,391 |
1,296 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
416 |
366 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
352 |
224 |
$16K |
| D1120 |
Prophylaxis - child |
690 |
628 |
$14K |
| D0272 |
Bitewings - two radiographic images |
913 |
840 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
156 |
106 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
740 |
690 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
643 |
563 |
$5K |
| D2160 |
|
33 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
57 |
55 |
$2K |
| D2140 |
|
54 |
26 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$262.45 |