| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,361 |
1,905 |
$57K |
| D0330 |
Panoramic radiographic image |
1,317 |
1,052 |
$33K |
| D1999 |
|
2,307 |
1,804 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,060 |
1,659 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,819 |
1,461 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,006 |
804 |
$17K |
| D1351 |
Sealant - per tooth |
853 |
111 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
775 |
617 |
$10K |
| D1120 |
Prophylaxis - child |
316 |
237 |
$5K |
| D2330 |
|
113 |
36 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
37 |
$2K |
| D2140 |
|
59 |
42 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
26 |
$805.40 |