| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,203 |
3,862 |
$116K |
| D1999 |
|
4,544 |
4,166 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
3,955 |
3,620 |
$54K |
| D0272 |
Bitewings - two radiographic images |
3,091 |
2,803 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
623 |
437 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,563 |
1,383 |
$21K |
| D0330 |
Panoramic radiographic image |
408 |
397 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
600 |
493 |
$11K |
| D1120 |
Prophylaxis - child |
449 |
362 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
162 |
116 |
$5K |
| D2160 |
|
46 |
36 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
320 |
276 |
$2K |
| D2140 |
|
46 |
37 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
26 |
$267.42 |