| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,874 |
2,589 |
$84K |
| D1999 |
|
3,371 |
3,046 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,424 |
1,307 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,954 |
1,712 |
$27K |
| D0330 |
Panoramic radiographic image |
602 |
564 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,321 |
1,248 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
614 |
393 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,822 |
1,447 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
889 |
762 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
675 |
572 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
868 |
838 |
$7K |
| D1120 |
Prophylaxis - child |
249 |
199 |
$5K |
| D2335 |
|
49 |
37 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
15 |
$896.54 |
| D2140 |
|
19 |
15 |
$753.73 |