| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,878 |
3,008 |
$104K |
| D0330 |
Panoramic radiographic image |
1,889 |
1,449 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,861 |
2,206 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
2,867 |
2,190 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,116 |
863 |
$20K |
| D1999 |
|
920 |
797 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
301 |
176 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
494 |
354 |
$7K |
| D2140 |
|
78 |
52 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$446.99 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$173.86 |