| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,557 |
3,826 |
$131K |
| D1999 |
|
6,214 |
4,895 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
4,726 |
3,979 |
$66K |
| D0330 |
Panoramic radiographic image |
1,100 |
925 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,024 |
801 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,396 |
1,127 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,171 |
961 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
278 |
211 |
$9K |
| D2140 |
|
273 |
199 |
$8K |
| D2160 |
|
88 |
68 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
95 |
$4K |
| D1120 |
Prophylaxis - child |
222 |
161 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
489 |
386 |
$3K |
| D2330 |
|
113 |
84 |
$3K |
| D2335 |
|
14 |
12 |
$565.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$169.06 |