| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,801 |
3,186 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
3,890 |
3,184 |
$53K |
| D1999 |
|
3,165 |
2,765 |
$50K |
| D0330 |
Panoramic radiographic image |
1,683 |
1,400 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,012 |
912 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
500 |
315 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,215 |
1,023 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
907 |
780 |
$13K |
| D2140 |
|
291 |
181 |
$8K |
| D1120 |
Prophylaxis - child |
228 |
194 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
62 |
51 |
$2K |
| D2940 |
|
29 |
26 |
$709.00 |
| D0220 |
Intraoral - periapical first radiographic image |
58 |
53 |
$352.54 |