| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,553 |
2,959 |
$100K |
| D1999 |
|
4,833 |
4,006 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
3,423 |
2,823 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,578 |
2,171 |
$38K |
| D0330 |
Panoramic radiographic image |
677 |
584 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
644 |
578 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
319 |
193 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
331 |
169 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
692 |
615 |
$10K |
| D2140 |
|
182 |
111 |
$5K |
| D1120 |
Prophylaxis - child |
203 |
177 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
211 |
151 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
202 |
158 |
$1K |