| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,865 |
3,667 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,861 |
2,768 |
$55K |
| D0330 |
Panoramic radiographic image |
1,903 |
1,823 |
$54K |
| D0272 |
Bitewings - two radiographic images |
3,207 |
3,053 |
$46K |
| D1999 |
|
2,209 |
2,000 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,217 |
2,079 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,919 |
1,852 |
$27K |
| D1120 |
Prophylaxis - child |
980 |
962 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
132 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
97 |
97 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
135 |
105 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
541 |
516 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
223 |
207 |
$3K |
| D2140 |
|
65 |
54 |
$2K |