| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,165 |
1,001 |
$27K |
| D0330 |
Panoramic radiographic image |
635 |
545 |
$15K |
| D1999 |
|
881 |
790 |
$15K |
| D0272 |
Bitewings - two radiographic images |
938 |
818 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
847 |
731 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
501 |
430 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
409 |
353 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
207 |
182 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
106 |
76 |
$3K |
| D2140 |
|
113 |
73 |
$2K |
| D1120 |
Prophylaxis - child |
149 |
135 |
$2K |
| D2330 |
|
20 |
15 |
$446.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$315.00 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$149.17 |