| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,174 |
2,110 |
$59K |
| D1999 |
|
3,145 |
2,848 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,777 |
1,726 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,825 |
1,095 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,101 |
1,069 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
633 |
616 |
$14K |
| D0330 |
Panoramic radiographic image |
280 |
278 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,214 |
1,178 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
608 |
597 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
176 |
122 |
$6K |
| D1120 |
Prophylaxis - child |
252 |
244 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
71 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
38 |
$2K |
| D2140 |
|
39 |
27 |
$816.20 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$580.58 |