| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,975 |
2,532 |
$78K |
| D1999 |
|
4,420 |
3,697 |
$66K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,092 |
674 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,722 |
1,477 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,330 |
2,013 |
$32K |
| D0330 |
Panoramic radiographic image |
969 |
909 |
$29K |
| D2140 |
|
777 |
448 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,800 |
1,561 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
301 |
241 |
$20K |
| D2160 |
|
399 |
307 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,001 |
846 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
633 |
572 |
$9K |
| D1120 |
Prophylaxis - child |
444 |
381 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,421 |
952 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
822 |
753 |
$5K |
| D2161 |
|
107 |
53 |
$4K |
| D1351 |
Sealant - per tooth |
85 |
15 |
$1K |