| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,577 |
2,785 |
$101K |
| D1999 |
|
4,574 |
3,423 |
$68K |
| D0330 |
Panoramic radiographic image |
1,659 |
1,289 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,339 |
712 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,971 |
2,310 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,988 |
2,298 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,381 |
1,084 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,401 |
1,071 |
$19K |
| D1120 |
Prophylaxis - child |
549 |
430 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,491 |
1,148 |
$10K |
| D2140 |
|
387 |
234 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
322 |
206 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,427 |
1,082 |
$9K |
| D2160 |
|
200 |
143 |
$7K |
| D1351 |
Sealant - per tooth |
96 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
67 |
$956.12 |