| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,356 |
1,114 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,609 |
1,303 |
$17K |
| D0330 |
Panoramic radiographic image |
589 |
479 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,056 |
866 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
356 |
248 |
$8K |
| D2140 |
|
336 |
237 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
464 |
375 |
$6K |
| D1120 |
Prophylaxis - child |
238 |
204 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
106 |
94 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
28 |
$1K |
| D2940 |
|
63 |
45 |
$1K |
| D2331 |
|
23 |
17 |
$685.50 |
| D1999 |
|
77 |
67 |
$275.69 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
53 |
$269.80 |