| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
7,017 |
5,094 |
$96K |
| D1110 |
Prophylaxis - adult |
2,807 |
2,430 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
775 |
507 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,890 |
1,607 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,817 |
1,604 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,042 |
882 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
965 |
854 |
$13K |
| D2160 |
|
210 |
156 |
$10K |
| D2140 |
|
290 |
196 |
$10K |
| D1120 |
Prophylaxis - child |
349 |
306 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
594 |
521 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$909.84 |
| D0330 |
Panoramic radiographic image |
24 |
13 |
$724.62 |
| D0140 |
Limited oral evaluation - problem focused |
21 |
12 |
$416.04 |