| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
740 |
673 |
$19K |
| D1999 |
|
1,079 |
976 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
501 |
457 |
$7K |
| D0272 |
Bitewings - two radiographic images |
438 |
414 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
284 |
281 |
$6K |
| D0330 |
Panoramic radiographic image |
113 |
111 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
79 |
48 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
175 |
173 |
$2K |
| D2140 |
|
23 |
14 |
$796.41 |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
21 |
$563.70 |
| D1120 |
Prophylaxis - child |
23 |
23 |
$372.60 |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
57 |
$317.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
54 |
$244.50 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$140.40 |