| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,452 |
2,147 |
$65K |
| D0330 |
Panoramic radiographic image |
1,515 |
1,338 |
$40K |
| D1999 |
|
2,390 |
2,144 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,806 |
1,567 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,110 |
1,865 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,383 |
1,210 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
582 |
274 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,041 |
889 |
$14K |
| D1120 |
Prophylaxis - child |
511 |
443 |
$8K |
| D2140 |
|
284 |
164 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
182 |
103 |
$4K |
| D2160 |
|
60 |
40 |
$2K |