| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,094 |
5,531 |
$157K |
| D1999 |
|
6,528 |
5,978 |
$93K |
| D0330 |
Panoramic radiographic image |
3,101 |
2,786 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
5,465 |
5,008 |
$73K |
| D0272 |
Bitewings - two radiographic images |
4,514 |
4,092 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,511 |
2,238 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,883 |
2,621 |
$40K |
| D1120 |
Prophylaxis - child |
1,759 |
1,604 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
353 |
272 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
24 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
55 |
$453.85 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$246.74 |