| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
4,577 |
3,078 |
$132K |
| D1120 |
Prophylaxis - child |
4,211 |
3,379 |
$99K |
| D0330 |
Panoramic radiographic image |
2,084 |
1,606 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,110 |
1,531 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,847 |
1,608 |
$44K |
| D2140 |
|
802 |
309 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,200 |
1,650 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
358 |
113 |
$15K |
| D0272 |
Bitewings - two radiographic images |
742 |
497 |
$10K |
| D0274 |
Bitewings - four radiographic images |
370 |
317 |
$10K |
| D1206 |
Topical application of fluoride varnish |
257 |
245 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
394 |
190 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
18 |
17 |
$0.00 |