| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,304 |
1,999 |
$58K |
| D1999 |
|
2,001 |
1,822 |
$28K |
| D0330 |
Panoramic radiographic image |
936 |
808 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,849 |
1,611 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,704 |
1,470 |
$24K |
| D1351 |
Sealant - per tooth |
1,356 |
193 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
982 |
825 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,044 |
887 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,316 |
680 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
373 |
206 |
$12K |
| D1120 |
Prophylaxis - child |
525 |
434 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
813 |
687 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
89 |
$5K |
| D2160 |
|
85 |
38 |
$3K |