| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,808 |
3,634 |
$96K |
| D1999 |
|
4,940 |
4,501 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
3,145 |
3,018 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,121 |
707 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,823 |
2,698 |
$39K |
| D0330 |
Panoramic radiographic image |
1,249 |
1,189 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,283 |
1,220 |
$22K |
| D2140 |
|
728 |
460 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,358 |
1,296 |
$18K |
| D2160 |
|
295 |
224 |
$12K |
| D1120 |
Prophylaxis - child |
669 |
642 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
102 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
536 |
497 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
169 |
167 |
$3K |
| D2335 |
|
30 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
47 |
39 |
$381.92 |