| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,144 |
2,321 |
$86K |
| D1999 |
|
4,192 |
3,050 |
$63K |
| D0272 |
Bitewings - two radiographic images |
2,829 |
2,070 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
2,869 |
2,223 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
972 |
465 |
$30K |
| D0330 |
Panoramic radiographic image |
1,038 |
720 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,456 |
1,014 |
$26K |
| D2140 |
|
1,017 |
450 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,661 |
1,257 |
$23K |
| D1120 |
Prophylaxis - child |
1,065 |
826 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
280 |
155 |
$8K |
| D2160 |
|
65 |
54 |
$2K |
| D2330 |
|
49 |
28 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
44 |
$561.06 |
| D0220 |
Intraoral - periapical first radiographic image |
91 |
91 |
$497.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
40 |
$210.00 |