| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,091 |
2,942 |
$82K |
| D1999 |
|
5,521 |
5,298 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
3,890 |
3,729 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,328 |
3,162 |
$46K |
| D1120 |
Prophylaxis - child |
2,277 |
2,157 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,615 |
1,490 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,198 |
2,099 |
$31K |
| D0330 |
Panoramic radiographic image |
918 |
881 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
526 |
300 |
$22K |
| D1351 |
Sealant - per tooth |
1,207 |
178 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
195 |
119 |
$12K |
| D2140 |
|
191 |
124 |
$7K |
| D2160 |
|
29 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
117 |
89 |
$729.40 |
| D2940 |
|
13 |
12 |
$406.25 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$270.14 |