| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,025 |
846 |
$23K |
| D0272 |
Bitewings - two radiographic images |
905 |
757 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
872 |
716 |
$9K |
| D0330 |
Panoramic radiographic image |
326 |
255 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
560 |
453 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
440 |
359 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
240 |
121 |
$6K |
| D1120 |
Prophylaxis - child |
323 |
265 |
$5K |
| D1999 |
|
281 |
235 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
42 |
$1K |
| D2331 |
|
19 |
12 |
$563.00 |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
86 |
$549.70 |
| D2140 |
|
23 |
14 |
$494.80 |
| D0140 |
Limited oral evaluation - problem focused |
22 |
12 |
$257.40 |