| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,826 |
1,687 |
$49K |
| D1999 |
|
2,346 |
2,135 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
579 |
517 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,002 |
887 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
983 |
927 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
469 |
415 |
$7K |
| D0272 |
Bitewings - two radiographic images |
416 |
383 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
170 |
87 |
$5K |
| D2160 |
|
119 |
50 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
583 |
408 |
$4K |
| D0330 |
Panoramic radiographic image |
121 |
113 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
90 |
76 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
139 |
137 |
$1K |
| D2140 |
|
28 |
13 |
$812.04 |