| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,391 |
2,830 |
$91K |
| D1999 |
|
3,788 |
3,318 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,722 |
2,256 |
$54K |
| D0330 |
Panoramic radiographic image |
1,690 |
1,392 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,158 |
1,776 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,160 |
1,812 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
2,098 |
1,818 |
$28K |
| D1120 |
Prophylaxis - child |
1,196 |
978 |
$22K |
| D2161 |
|
286 |
177 |
$16K |
| D2140 |
|
315 |
171 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
293 |
258 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
734 |
657 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
616 |
482 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
62 |
42 |
$2K |
| D2335 |
|
23 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
28 |
$1K |
| D2940 |
|
35 |
24 |
$649.25 |