| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,864 |
3,423 |
$115K |
| D1999 |
|
7,054 |
5,985 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
3,239 |
2,811 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,062 |
1,902 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,984 |
1,761 |
$30K |
| D1120 |
Prophylaxis - child |
1,262 |
1,123 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
459 |
333 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,213 |
1,102 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
82 |
$5K |
| D0330 |
Panoramic radiographic image |
106 |
106 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
276 |
254 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
108 |
$2K |
| D2335 |
|
19 |
13 |
$1K |
| D2140 |
|
18 |
12 |
$713.06 |
| D0230 |
Intraoral - periapical each additional radiographic image |
54 |
46 |
$214.80 |