| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,857 |
5,209 |
$156K |
| D0330 |
Panoramic radiographic image |
3,429 |
2,935 |
$96K |
| D1999 |
|
5,908 |
5,469 |
$87K |
| D0272 |
Bitewings - two radiographic images |
5,282 |
4,636 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
4,824 |
4,290 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,594 |
2,280 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,218 |
2,774 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,170 |
740 |
$40K |
| D1120 |
Prophylaxis - child |
1,407 |
1,201 |
$25K |
| D2140 |
|
671 |
378 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
502 |
471 |
$9K |
| D1351 |
Sealant - per tooth |
527 |
60 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
781 |
740 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
26 |
$1K |