| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,548 |
1,456 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,001 |
268 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,250 |
2,153 |
$56K |
| D1120 |
Prophylaxis - child |
1,279 |
1,249 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,019 |
1,954 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,268 |
1,148 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,196 |
1,145 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
228 |
210 |
$18K |
| D0330 |
Panoramic radiographic image |
80 |
69 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
205 |
189 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
43 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
12 |
$1K |
| D0603 |
|
48 |
32 |
$210.00 |