| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
465 |
405 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
468 |
404 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
258 |
143 |
$6K |
| D0330 |
Panoramic radiographic image |
233 |
201 |
$5K |
| D0272 |
Bitewings - two radiographic images |
388 |
343 |
$5K |
| D2140 |
|
200 |
101 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
208 |
184 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
129 |
65 |
$3K |
| D1120 |
Prophylaxis - child |
114 |
98 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
145 |
127 |
$1K |
| D2160 |
|
40 |
29 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
83 |
$959.40 |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
96 |
$556.80 |