| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,002 |
1,748 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,488 |
1,261 |
$29K |
| D1999 |
|
1,992 |
1,604 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,003 |
834 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
224 |
121 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,106 |
941 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
612 |
568 |
$8K |
| D0330 |
Panoramic radiographic image |
188 |
184 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
769 |
269 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
347 |
287 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
76 |
38 |
$3K |
| D1120 |
Prophylaxis - child |
133 |
113 |
$2K |
| D2140 |
|
51 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
39 |
$602.90 |