| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,862 |
1,687 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,936 |
1,777 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
620 |
568 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,179 |
1,076 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
255 |
138 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
487 |
453 |
$17K |
| D1120 |
Prophylaxis - child |
391 |
363 |
$11K |
| D0272 |
Bitewings - two radiographic images |
476 |
422 |
$11K |
| D1206 |
Topical application of fluoride varnish |
217 |
210 |
$5K |
| D0330 |
Panoramic radiographic image |
73 |
70 |
$4K |
| D2140 |
|
66 |
37 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
44 |
$2K |
| D0274 |
Bitewings - four radiographic images |
39 |
38 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
83 |
70 |
$986.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
32 |
14 |
$0.00 |