| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,634 |
3,883 |
$131K |
| D1999 |
|
5,736 |
5,040 |
$86K |
| D0330 |
Panoramic radiographic image |
2,114 |
1,753 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,063 |
2,487 |
$62K |
| D0272 |
Bitewings - two radiographic images |
3,635 |
3,045 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
3,373 |
2,886 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,710 |
2,252 |
$38K |
| D1120 |
Prophylaxis - child |
1,648 |
1,373 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
731 |
515 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
57 |
$2K |
| D2160 |
|
46 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
102 |
$2K |
| D2140 |
|
79 |
41 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
49 |
40 |
$322.96 |