| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,725 |
2,370 |
$71K |
| D0330 |
Panoramic radiographic image |
1,276 |
1,128 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,435 |
1,246 |
$25K |
| D1999 |
|
1,545 |
1,395 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,389 |
1,266 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,601 |
1,359 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
637 |
254 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
826 |
673 |
$9K |
| D1120 |
Prophylaxis - child |
470 |
382 |
$7K |
| D2140 |
|
252 |
113 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
190 |
96 |
$4K |
| D2160 |
|
82 |
59 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
43 |
$244.45 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$140.40 |