| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,511 |
3,818 |
$123K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,402 |
1,430 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
4,691 |
3,931 |
$59K |
| D0330 |
Panoramic radiographic image |
1,856 |
1,598 |
$53K |
| D1999 |
|
3,875 |
3,374 |
$51K |
| D0272 |
Bitewings - two radiographic images |
3,391 |
2,889 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,031 |
629 |
$32K |
| D2160 |
|
718 |
472 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,816 |
1,477 |
$25K |
| D2140 |
|
763 |
499 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
916 |
769 |
$16K |
| D1120 |
Prophylaxis - child |
894 |
724 |
$15K |
| D2335 |
|
164 |
64 |
$8K |
| D1351 |
Sealant - per tooth |
204 |
37 |
$3K |
| D2332 |
|
46 |
12 |
$2K |