| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,431 |
2,044 |
$60K |
| D0330 |
Panoramic radiographic image |
1,057 |
916 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,940 |
1,596 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
864 |
476 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,896 |
1,566 |
$19K |
| D2140 |
|
886 |
427 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
970 |
823 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
901 |
736 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
395 |
236 |
$9K |
| D1120 |
Prophylaxis - child |
502 |
413 |
$8K |
| D1999 |
|
615 |
564 |
$5K |
| D2160 |
|
188 |
140 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
256 |
203 |
$3K |