| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,361 |
3,659 |
$120K |
| D1999 |
|
4,087 |
3,566 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
4,084 |
3,392 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,954 |
2,501 |
$41K |
| D0330 |
Panoramic radiographic image |
1,358 |
1,193 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
979 |
519 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,150 |
1,783 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,235 |
1,076 |
$23K |
| D1120 |
Prophylaxis - child |
906 |
756 |
$16K |
| D2140 |
|
591 |
326 |
$16K |
| D1351 |
Sealant - per tooth |
397 |
65 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
44 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
83 |
$1K |
| D2160 |
|
30 |
28 |
$872.90 |
| D0230 |
Intraoral - periapical each additional radiographic image |
125 |
96 |
$691.90 |