| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,096 |
1,901 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,440 |
1,310 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,692 |
1,558 |
$23K |
| D1999 |
|
1,415 |
1,260 |
$19K |
| D0330 |
Panoramic radiographic image |
476 |
463 |
$14K |
| D2140 |
|
488 |
225 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
801 |
713 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
838 |
764 |
$9K |
| D1120 |
Prophylaxis - child |
409 |
357 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
240 |
148 |
$5K |
| D2335 |
|
73 |
37 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
239 |
168 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
55 |
42 |
$1K |
| D9110 |
|
125 |
79 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
241 |
189 |
$947.12 |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
42 |
$177.00 |