| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,782 |
1,782 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,090 |
2,090 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,050 |
1,022 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,749 |
1,749 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,269 |
1,269 |
$23K |
| D1120 |
Prophylaxis - child |
589 |
589 |
$21K |
| D0274 |
Bitewings - four radiographic images |
748 |
748 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,468 |
1,430 |
$17K |
| D2160 |
|
125 |
91 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
247 |
247 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
88 |
77 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
50 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
316 |
243 |
$3K |
| D0330 |
Panoramic radiographic image |
40 |
40 |
$2K |