| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,422 |
1,281 |
$39K |
| D1999 |
|
1,924 |
1,787 |
$27K |
| D0330 |
Panoramic radiographic image |
631 |
569 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
879 |
765 |
$17K |
| D0272 |
Bitewings - two radiographic images |
891 |
806 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
302 |
156 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
566 |
520 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
244 |
226 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
49 |
39 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
213 |
163 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
195 |
181 |
$1K |
| D2160 |
|
19 |
14 |
$947.65 |
| D1120 |
Prophylaxis - child |
47 |
29 |
$840.80 |
| D2140 |
|
18 |
12 |
$667.89 |