| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,083 |
4,900 |
$133K |
| D0330 |
Panoramic radiographic image |
3,017 |
2,909 |
$86K |
| D1999 |
|
5,207 |
4,857 |
$76K |
| D0272 |
Bitewings - two radiographic images |
4,303 |
4,140 |
$61K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,576 |
1,164 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
4,146 |
3,977 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,073 |
1,991 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,963 |
1,879 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
707 |
497 |
$25K |
| D2140 |
|
520 |
427 |
$15K |
| D1120 |
Prophylaxis - child |
611 |
580 |
$10K |
| D2160 |
|
47 |
39 |
$2K |
| D2330 |
|
50 |
37 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
13 |
$875.80 |
| D2331 |
|
16 |
12 |
$868.16 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$378.70 |
| D3221 |
|
14 |
14 |
$289.80 |