| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,590 |
3,171 |
$98K |
| D0330 |
Panoramic radiographic image |
1,832 |
1,626 |
$53K |
| D1999 |
|
3,091 |
2,784 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,902 |
2,549 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
2,910 |
2,571 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,399 |
1,223 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
684 |
381 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
659 |
372 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,392 |
1,227 |
$20K |
| D2140 |
|
675 |
293 |
$18K |
| D1120 |
Prophylaxis - child |
580 |
509 |
$10K |
| D2160 |
|
19 |
12 |
$911.56 |
| D0140 |
Limited oral evaluation - problem focused |
45 |
44 |
$691.45 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$46.80 |