| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,835 |
1,750 |
$54K |
| D1999 |
|
2,392 |
2,245 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,733 |
1,695 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,503 |
1,429 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,170 |
1,146 |
$17K |
| D1120 |
Prophylaxis - child |
672 |
664 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
652 |
608 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
757 |
719 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
700 |
599 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
45 |
38 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
25 |
$875.27 |
| D2160 |
|
18 |
13 |
$620.12 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$440.00 |
| D2140 |
|
20 |
18 |
$418.70 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$179.86 |