| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,482 |
2,280 |
$67K |
| D1999 |
|
2,345 |
2,157 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,824 |
1,678 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,777 |
1,641 |
$23K |
| D0330 |
Panoramic radiographic image |
785 |
678 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
832 |
753 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
551 |
490 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
751 |
740 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
732 |
702 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
140 |
99 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
118 |
96 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
66 |
$3K |
| D1120 |
Prophylaxis - child |
133 |
131 |
$2K |
| D2140 |
|
62 |
44 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
37 |
37 |
$488.16 |
| D2160 |
|
12 |
12 |
$415.99 |