| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,262 |
1,947 |
$58K |
| D1999 |
|
1,533 |
1,353 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,499 |
1,313 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
957 |
748 |
$15K |
| D0330 |
Panoramic radiographic image |
305 |
236 |
$9K |
| D2160 |
|
224 |
153 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
274 |
164 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
432 |
332 |
$6K |
| D0272 |
Bitewings - two radiographic images |
299 |
263 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
111 |
71 |
$4K |
| D1120 |
Prophylaxis - child |
201 |
150 |
$3K |
| D2335 |
|
42 |
28 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
120 |
97 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
24 |
$902.81 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
28 |
$118.70 |