| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,472 |
5,199 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
5,517 |
4,447 |
$74K |
| D1999 |
|
4,597 |
3,192 |
$64K |
| D0330 |
Panoramic radiographic image |
2,171 |
1,772 |
$64K |
| D0272 |
Bitewings - two radiographic images |
4,437 |
3,587 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
790 |
555 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,392 |
1,154 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
735 |
489 |
$23K |
| D2140 |
|
819 |
525 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,027 |
857 |
$14K |
| D2330 |
|
283 |
156 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
907 |
773 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
244 |
203 |
$4K |
| D1120 |
Prophylaxis - child |
202 |
173 |
$3K |
| D2160 |
|
67 |
54 |
$3K |
| D2335 |
|
46 |
26 |
$2K |