| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,379 |
3,755 |
$118K |
| D1999 |
|
4,622 |
3,874 |
$68K |
| D0330 |
Panoramic radiographic image |
2,137 |
1,878 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,468 |
828 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,725 |
2,403 |
$49K |
| D0272 |
Bitewings - two radiographic images |
3,335 |
2,890 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,248 |
1,896 |
$32K |
| D2140 |
|
809 |
458 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,211 |
1,072 |
$16K |
| D2160 |
|
363 |
235 |
$15K |
| D1120 |
Prophylaxis - child |
484 |
405 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
312 |
261 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
478 |
395 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
30 |
$3K |
| D2330 |
|
62 |
19 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
40 |
$2K |
| D2335 |
|
22 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
237 |
162 |
$1K |