| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,758 |
3,061 |
$120K |
| D1999 |
|
6,490 |
5,322 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,208 |
2,564 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,560 |
2,089 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,536 |
1,314 |
$37K |
| D0330 |
Panoramic radiographic image |
1,119 |
947 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,694 |
1,423 |
$25K |
| D1120 |
Prophylaxis - child |
1,014 |
849 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
264 |
191 |
$13K |
| D2140 |
|
215 |
145 |
$8K |
| D2335 |
|
18 |
13 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
13 |
$972.68 |
| D2940 |
|
20 |
18 |
$611.95 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$223.60 |