| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,695 |
2,629 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
980 |
970 |
$42K |
| D1120 |
Prophylaxis - child |
709 |
679 |
$35K |
| D0330 |
Panoramic radiographic image |
848 |
837 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
3,111 |
3,021 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
231 |
230 |
$18K |
| D0272 |
Bitewings - two radiographic images |
3,539 |
3,438 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,429 |
3,328 |
$7K |
| D1330 |
|
3,654 |
3,549 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
2,379 |
2,125 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
292 |
279 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
866 |
564 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
15 |
$2K |
| D1999 |
|
95 |
85 |
$78.75 |