| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,137 |
2,648 |
$81K |
| D1999 |
|
3,492 |
3,089 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,791 |
2,419 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,492 |
2,084 |
$35K |
| D0330 |
Panoramic radiographic image |
976 |
763 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,227 |
953 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,301 |
1,050 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
334 |
199 |
$10K |
| D1120 |
Prophylaxis - child |
518 |
433 |
$8K |
| D2140 |
|
344 |
173 |
$8K |
| D1351 |
Sealant - per tooth |
363 |
43 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
689 |
600 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
447 |
358 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
56 |
$2K |
| D2330 |
|
27 |
12 |
$610.02 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$179.82 |