| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,651 |
3,590 |
$130K |
| D1999 |
|
4,409 |
3,544 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
3,656 |
2,748 |
$51K |
| D0272 |
Bitewings - two radiographic images |
3,097 |
2,351 |
$44K |
| D0330 |
Panoramic radiographic image |
1,375 |
1,096 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,557 |
1,231 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,479 |
756 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,438 |
1,017 |
$20K |
| D1351 |
Sealant - per tooth |
649 |
76 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,087 |
761 |
$8K |
| D1120 |
Prophylaxis - child |
439 |
287 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
184 |
68 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
14 |
$1K |