| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
3,660 |
3,445 |
$56K |
| D1110 |
Prophylaxis - adult |
2,154 |
2,078 |
$56K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
980 |
643 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,352 |
2,262 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,710 |
1,648 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,621 |
1,560 |
$22K |
| D1120 |
Prophylaxis - child |
951 |
907 |
$16K |
| D2140 |
|
450 |
299 |
$13K |
| D1351 |
Sealant - per tooth |
889 |
183 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
633 |
607 |
$12K |
| D0330 |
Panoramic radiographic image |
361 |
341 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
78 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
278 |
270 |
$2K |