| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,664 |
5,002 |
$159K |
| D0330 |
Panoramic radiographic image |
2,586 |
2,251 |
$75K |
| D1999 |
|
4,376 |
3,949 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
4,226 |
3,759 |
$57K |
| D0272 |
Bitewings - two radiographic images |
3,989 |
3,520 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,926 |
1,695 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
510 |
419 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
65 |
52 |
$3K |
| D1120 |
Prophylaxis - child |
142 |
125 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
58 |
$2K |