| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,790 |
3,723 |
$138K |
| D1999 |
|
5,755 |
4,292 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,991 |
3,025 |
$56K |
| D0272 |
Bitewings - two radiographic images |
3,457 |
2,698 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,834 |
1,465 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,164 |
1,645 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
622 |
384 |
$26K |
| D1120 |
Prophylaxis - child |
1,191 |
899 |
$23K |
| D0330 |
Panoramic radiographic image |
551 |
512 |
$15K |
| D2160 |
|
232 |
157 |
$10K |
| D2140 |
|
251 |
174 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
211 |
147 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
784 |
590 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
154 |
$4K |
| D2161 |
|
34 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
25 |
$199.06 |