| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,429 |
4,677 |
$149K |
| D1999 |
|
4,537 |
3,569 |
$67K |
| D0330 |
Panoramic radiographic image |
2,260 |
1,968 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
4,626 |
3,919 |
$63K |
| D0272 |
Bitewings - two radiographic images |
4,042 |
3,497 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,946 |
1,754 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,689 |
1,435 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,869 |
1,403 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,630 |
1,353 |
$13K |
| D1120 |
Prophylaxis - child |
573 |
515 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
298 |
201 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
172 |
124 |
$6K |
| D2140 |
|
86 |
67 |
$2K |