| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,231 |
2,918 |
$81K |
| D0330 |
Panoramic radiographic image |
2,453 |
2,160 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,466 |
2,130 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,274 |
2,096 |
$31K |
| D1999 |
|
1,909 |
1,816 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,786 |
1,714 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,161 |
1,047 |
$16K |
| D1120 |
Prophylaxis - child |
563 |
506 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
236 |
113 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
75 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
166 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
44 |
$545.48 |