| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
11,224 |
10,332 |
$296K |
| D0330 |
Panoramic radiographic image |
5,890 |
5,372 |
$170K |
| D1999 |
|
10,206 |
9,359 |
$152K |
| D0120 |
Periodic oral evaluation - established patient |
10,582 |
9,782 |
$144K |
| D0272 |
Bitewings - two radiographic images |
9,447 |
8,634 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,669 |
5,169 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,685 |
3,312 |
$76K |
| D2140 |
|
2,376 |
1,435 |
$73K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,773 |
1,379 |
$68K |
| D1120 |
Prophylaxis - child |
3,093 |
2,849 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
663 |
336 |
$30K |
| D2330 |
|
560 |
340 |
$21K |
| D2335 |
|
328 |
221 |
$18K |
| D2160 |
|
56 |
38 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$392.79 |