| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,897 |
1,556 |
$49K |
| D1999 |
|
1,215 |
1,061 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,329 |
1,111 |
$16K |
| D0330 |
Panoramic radiographic image |
544 |
453 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
574 |
484 |
$9K |
| D0272 |
Bitewings - two radiographic images |
492 |
435 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
350 |
276 |
$5K |
| D2140 |
|
138 |
55 |
$3K |
| D1120 |
Prophylaxis - child |
174 |
130 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
102 |
64 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
48 |
$948.62 |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
24 |
$746.90 |