| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,256 |
4,564 |
$148K |
| D1999 |
|
5,516 |
4,801 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
4,716 |
4,125 |
$67K |
| D0272 |
Bitewings - two radiographic images |
3,705 |
3,261 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,099 |
766 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,582 |
1,375 |
$30K |
| D0330 |
Panoramic radiographic image |
934 |
907 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,998 |
1,740 |
$28K |
| D1120 |
Prophylaxis - child |
879 |
776 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
543 |
363 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,783 |
1,069 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,352 |
1,205 |
$9K |
| D2160 |
|
186 |
141 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
297 |
261 |
$4K |
| D2140 |
|
97 |
72 |
$3K |
| D2940 |
|
15 |
13 |
$269.00 |