| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,820 |
4,645 |
$125K |
| D1999 |
|
6,062 |
5,448 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
4,348 |
4,222 |
$59K |
| D0330 |
Panoramic radiographic image |
2,074 |
1,976 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,036 |
670 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,508 |
2,405 |
$36K |
| D2140 |
|
1,038 |
641 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,494 |
1,406 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,013 |
1,945 |
$28K |
| D1120 |
Prophylaxis - child |
842 |
813 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
969 |
924 |
$11K |
| D2335 |
|
192 |
113 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
199 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,258 |
1,189 |
$8K |
| D2160 |
|
73 |
62 |
$3K |
| D2161 |
|
14 |
13 |
$749.10 |