| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,085 |
1,941 |
$48K |
| D0330 |
Panoramic radiographic image |
1,406 |
1,296 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,635 |
1,514 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,835 |
1,697 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
455 |
311 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
954 |
903 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,050 |
998 |
$12K |
| D1120 |
Prophylaxis - child |
506 |
479 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,749 |
390 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
54 |
$3K |
| D2160 |
|
51 |
39 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
399 |
384 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
12 |
$826.36 |
| D2140 |
|
24 |
14 |
$518.40 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$140.40 |