| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,211 |
1,113 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,061 |
978 |
$24K |
| D0274 |
Bitewings - four radiographic images |
411 |
371 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
221 |
204 |
$7K |
| D0330 |
Panoramic radiographic image |
92 |
79 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
312 |
272 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
38 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
89 |
66 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
41 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
64 |
62 |
$995.31 |
| D0230 |
Intraoral - periapical each additional radiographic image |
72 |
59 |
$885.07 |