| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,398 |
3,229 |
$100K |
| D1999 |
|
4,718 |
4,488 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
3,177 |
3,028 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,684 |
2,521 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,418 |
2,260 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,373 |
1,265 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
605 |
385 |
$24K |
| D1120 |
Prophylaxis - child |
1,259 |
1,170 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,129 |
884 |
$22K |
| D0330 |
Panoramic radiographic image |
420 |
386 |
$12K |
| D1351 |
Sealant - per tooth |
748 |
101 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,113 |
1,077 |
$9K |
| D2140 |
|
153 |
106 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
92 |
54 |
$2K |
| D2160 |
|
31 |
24 |
$2K |