| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,275 |
2,719 |
$90K |
| D1999 |
|
3,489 |
2,935 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
3,238 |
2,704 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,999 |
1,662 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,683 |
1,368 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,222 |
967 |
$23K |
| D1120 |
Prophylaxis - child |
926 |
745 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
620 |
352 |
$15K |
| D0330 |
Panoramic radiographic image |
237 |
206 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
223 |
127 |
$6K |
| D2140 |
|
158 |
88 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
325 |
67 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
283 |
213 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
20 |
20 |
$970.00 |
| D2160 |
|
17 |
15 |
$510.30 |