| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,883 |
4,680 |
$155K |
| D1999 |
|
7,414 |
5,866 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
5,409 |
4,310 |
$70K |
| D0330 |
Panoramic radiographic image |
1,955 |
1,483 |
$56K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,146 |
765 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,323 |
1,838 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,184 |
1,628 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,677 |
2,216 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,111 |
849 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
999 |
903 |
$17K |
| D2140 |
|
616 |
400 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
150 |
109 |
$14K |
| D1120 |
Prophylaxis - child |
766 |
581 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
156 |
132 |
$4K |
| D2160 |
|
21 |
21 |
$705.89 |
| D2331 |
|
18 |
16 |
$549.56 |