| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,611 |
4,856 |
$154K |
| D1999 |
|
5,791 |
5,116 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
5,825 |
4,943 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,677 |
918 |
$59K |
| D0272 |
Bitewings - two radiographic images |
4,134 |
3,578 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,858 |
2,441 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,031 |
652 |
$32K |
| D0330 |
Panoramic radiographic image |
1,094 |
988 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,291 |
1,182 |
$25K |
| D1120 |
Prophylaxis - child |
1,391 |
1,151 |
$24K |
| D2140 |
|
352 |
181 |
$8K |
| D2160 |
|
175 |
125 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
706 |
587 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
572 |
316 |
$4K |