| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,289 |
5,036 |
$137K |
| D1999 |
|
6,806 |
6,340 |
$98K |
| D2140 |
|
3,149 |
1,643 |
$95K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,045 |
1,407 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
4,301 |
4,087 |
$58K |
| D0330 |
Panoramic radiographic image |
1,786 |
1,706 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,399 |
2,298 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,654 |
2,504 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,352 |
2,246 |
$33K |
| D2160 |
|
581 |
471 |
$25K |
| D1120 |
Prophylaxis - child |
1,146 |
1,104 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
473 |
465 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
895 |
826 |
$5K |
| D9995 |
|
382 |
380 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
92 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
556 |
395 |
$2K |