| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,549 |
4,152 |
$117K |
| D1999 |
|
4,954 |
4,365 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
5,150 |
4,662 |
$67K |
| D0272 |
Bitewings - two radiographic images |
4,627 |
4,169 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,206 |
2,862 |
$44K |
| D2335 |
|
682 |
440 |
$39K |
| D1120 |
Prophylaxis - child |
1,948 |
1,731 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,495 |
1,351 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
601 |
466 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,392 |
937 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,471 |
1,285 |
$10K |
| D2160 |
|
205 |
162 |
$8K |
| D2161 |
|
51 |
40 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
39 |
$1K |
| D2940 |
|
30 |
30 |
$680.83 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$413.37 |
| D2140 |
|
19 |
14 |
$400.36 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$370.32 |