| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,426 |
6,047 |
$172K |
| D1999 |
|
5,858 |
5,587 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
4,686 |
4,436 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,939 |
2,720 |
$61K |
| D0272 |
Bitewings - two radiographic images |
4,215 |
3,950 |
$61K |
| D0330 |
Panoramic radiographic image |
1,405 |
1,340 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,530 |
2,349 |
$34K |
| D1351 |
Sealant - per tooth |
1,239 |
115 |
$16K |
| D1120 |
Prophylaxis - child |
896 |
830 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
290 |
157 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
98 |
$10K |
| D2140 |
|
150 |
75 |
$5K |
| D2160 |
|
20 |
14 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
14 |
$666.90 |