| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,275 |
2,895 |
$86K |
| D1999 |
|
2,901 |
2,608 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,287 |
1,952 |
$43K |
| D0330 |
Panoramic radiographic image |
1,437 |
1,252 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,766 |
2,453 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
2,088 |
1,883 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,648 |
1,411 |
$23K |
| D1120 |
Prophylaxis - child |
872 |
728 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
146 |
88 |
$5K |
| D2140 |
|
121 |
76 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
276 |
229 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
78 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
330 |
286 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
16 |
$2K |
| D2160 |
|
32 |
16 |
$995.14 |
| D9110 |
|
16 |
14 |
$332.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
24 |
$126.10 |