| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,748 |
4,197 |
$125K |
| D1999 |
|
4,469 |
4,023 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
4,571 |
4,015 |
$60K |
| D0272 |
Bitewings - two radiographic images |
3,779 |
3,311 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,202 |
714 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,704 |
1,499 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,327 |
2,001 |
$32K |
| D1120 |
Prophylaxis - child |
1,240 |
1,064 |
$22K |
| D0330 |
Panoramic radiographic image |
529 |
508 |
$16K |
| D2140 |
|
444 |
282 |
$11K |
| D2160 |
|
265 |
159 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
881 |
770 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
81 |
56 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
21 |
20 |
$287.55 |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
33 |
$179.65 |