| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,595 |
3,176 |
$100K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,681 |
781 |
$62K |
| D2160 |
|
1,234 |
630 |
$56K |
| D1999 |
|
3,437 |
3,090 |
$52K |
| D0330 |
Panoramic radiographic image |
1,306 |
1,178 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,483 |
2,222 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
2,313 |
2,029 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,270 |
1,138 |
$26K |
| D2140 |
|
340 |
189 |
$9K |
| D2161 |
|
165 |
108 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
390 |
323 |
$5K |
| D1120 |
Prophylaxis - child |
84 |
74 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
16 |
$1K |