| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,603 |
2,919 |
$121K |
| D1999 |
|
4,931 |
3,988 |
$71K |
| D0330 |
Panoramic radiographic image |
1,483 |
1,246 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,396 |
1,858 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,563 |
1,321 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,342 |
1,891 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
989 |
763 |
$15K |
| D1120 |
Prophylaxis - child |
309 |
224 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
59 |
48 |
$3K |
| D3120 |
|
116 |
83 |
$3K |
| D2140 |
|
26 |
14 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
13 |
$616.60 |