| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,723 |
2,242 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,610 |
1,285 |
$27K |
| D1999 |
|
1,769 |
1,434 |
$25K |
| D0330 |
Panoramic radiographic image |
666 |
555 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,344 |
1,129 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
458 |
264 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
765 |
615 |
$10K |
| D2140 |
|
387 |
179 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
289 |
180 |
$7K |
| D1120 |
Prophylaxis - child |
310 |
244 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
126 |
94 |
$4K |
| D2335 |
|
86 |
51 |
$4K |
| D2160 |
|
71 |
43 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
61 |
$857.40 |