| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,618 |
1,452 |
$44K |
| D1999 |
|
2,385 |
2,110 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,124 |
995 |
$15K |
| D0272 |
Bitewings - two radiographic images |
956 |
851 |
$13K |
| D0330 |
Panoramic radiographic image |
438 |
395 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
282 |
184 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
527 |
476 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
234 |
189 |
$3K |
| D2160 |
|
30 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
12 |
$2K |
| D2140 |
|
39 |
14 |
$834.40 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$608.18 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$178.20 |