| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,480 |
3,812 |
$127K |
| D1999 |
|
5,286 |
4,664 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
4,343 |
3,659 |
$61K |
| D0330 |
Panoramic radiographic image |
1,422 |
1,222 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,781 |
2,328 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
834 |
448 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,167 |
1,802 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,458 |
1,260 |
$30K |
| D1120 |
Prophylaxis - child |
1,243 |
1,028 |
$23K |
| D2140 |
|
672 |
354 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
494 |
316 |
$20K |
| D1351 |
Sealant - per tooth |
1,393 |
101 |
$18K |
| D2160 |
|
34 |
26 |
$2K |