| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,236 |
1,905 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,532 |
1,270 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,685 |
1,442 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,503 |
1,301 |
$17K |
| D1999 |
|
1,169 |
990 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,131 |
937 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
512 |
276 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,918 |
1,206 |
$12K |
| D1120 |
Prophylaxis - child |
647 |
538 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,315 |
1,123 |
$8K |
| D0330 |
Panoramic radiographic image |
290 |
253 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
282 |
167 |
$7K |
| D2140 |
|
69 |
53 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
13 |
$714.74 |