| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,284 |
1,723 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,412 |
1,796 |
$24K |
| D0330 |
Panoramic radiographic image |
791 |
625 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,618 |
1,224 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,246 |
980 |
$16K |
| D1999 |
|
1,351 |
855 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
389 |
284 |
$12K |
| D1120 |
Prophylaxis - child |
703 |
552 |
$11K |
| D2140 |
|
410 |
277 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
589 |
466 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
238 |
163 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
434 |
317 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
100 |
$2K |
| D2940 |
|
34 |
31 |
$598.50 |
| D2160 |
|
17 |
16 |
$517.20 |
| D0431 |
|
152 |
79 |
$0.00 |
| D1330 |
|
293 |
154 |
$0.00 |