| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,053 |
896 |
$26K |
| D1999 |
|
652 |
543 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
700 |
597 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
374 |
306 |
$5K |
| D2140 |
|
242 |
107 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
105 |
$4K |
| D0272 |
Bitewings - two radiographic images |
257 |
185 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
194 |
148 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
49 |
$2K |
| D0330 |
Panoramic radiographic image |
74 |
42 |
$2K |
| D1120 |
Prophylaxis - child |
87 |
71 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
15 |
$622.30 |