| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,777 |
8,859 |
$330K |
| D0120 |
Periodic oral evaluation - established patient |
12,350 |
9,477 |
$170K |
| D1999 |
|
10,367 |
7,832 |
$157K |
| D0272 |
Bitewings - two radiographic images |
8,623 |
6,569 |
$127K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,517 |
1,491 |
$93K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,108 |
1,160 |
$90K |
| D0330 |
Panoramic radiographic image |
2,671 |
1,973 |
$86K |
| D2140 |
|
2,350 |
1,079 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,002 |
3,863 |
$71K |
| D1120 |
Prophylaxis - child |
2,199 |
1,699 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,542 |
1,016 |
$30K |
| D2160 |
|
259 |
184 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
236 |
207 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
272 |
258 |
$2K |