| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,586 |
1,966 |
$69K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,424 |
654 |
$49K |
| D1999 |
|
2,638 |
2,115 |
$37K |
| D2160 |
|
658 |
366 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,531 |
1,153 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,923 |
1,458 |
$27K |
| D0330 |
Panoramic radiographic image |
741 |
568 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,458 |
1,094 |
$20K |
| D2140 |
|
499 |
241 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
882 |
625 |
$12K |
| D1120 |
Prophylaxis - child |
389 |
263 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
414 |
277 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
360 |
219 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
74 |
$2K |
| D2331 |
|
23 |
13 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
28 |
$891.18 |
| D2940 |
|
22 |
13 |
$482.75 |