| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,926 |
1,838 |
$51K |
| D1999 |
|
2,639 |
2,491 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,026 |
972 |
$23K |
| D0330 |
Panoramic radiographic image |
686 |
655 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,215 |
1,159 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,151 |
1,084 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
582 |
550 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
95 |
$7K |
| D1120 |
Prophylaxis - child |
205 |
188 |
$4K |
| D1351 |
Sealant - per tooth |
211 |
24 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
42 |
33 |
$2K |
| D2140 |
|
20 |
12 |
$672.39 |