| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,341 |
2,141 |
$60K |
| D1999 |
|
3,055 |
2,559 |
$40K |
| D0330 |
Panoramic radiographic image |
1,160 |
1,060 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,992 |
1,825 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,862 |
1,711 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
514 |
285 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
793 |
707 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
930 |
833 |
$13K |
| D1120 |
Prophylaxis - child |
178 |
149 |
$3K |
| D2140 |
|
71 |
50 |
$2K |
| D2160 |
|
31 |
14 |
$971.80 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$410.04 |