| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,598 |
4,345 |
$126K |
| D1999 |
|
7,215 |
6,821 |
$108K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,184 |
1,243 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
4,209 |
4,033 |
$59K |
| D0272 |
Bitewings - two radiographic images |
4,029 |
3,779 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,166 |
1,975 |
$46K |
| D0330 |
Panoramic radiographic image |
1,377 |
1,327 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,633 |
2,458 |
$37K |
| D2160 |
|
641 |
482 |
$32K |
| D1120 |
Prophylaxis - child |
1,632 |
1,534 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,226 |
2,586 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,674 |
2,474 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
432 |
297 |
$18K |
| D2140 |
|
548 |
332 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
705 |
683 |
$12K |