| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,738 |
4,074 |
$132K |
| D1999 |
|
6,990 |
6,030 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
4,571 |
3,917 |
$65K |
| D0330 |
Panoramic radiographic image |
1,988 |
1,702 |
$59K |
| D0272 |
Bitewings - two radiographic images |
3,951 |
3,380 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,333 |
853 |
$53K |
| D2140 |
|
1,439 |
853 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,464 |
1,228 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,950 |
1,636 |
$28K |
| D1120 |
Prophylaxis - child |
1,386 |
1,164 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
100 |
$5K |
| D2160 |
|
28 |
13 |
$911.18 |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
28 |
$190.74 |