| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,352 |
1,848 |
$62K |
| D1999 |
|
2,293 |
1,856 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,190 |
477 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,603 |
1,230 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,491 |
1,203 |
$19K |
| D0330 |
Panoramic radiographic image |
502 |
368 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
732 |
543 |
$13K |
| D2160 |
|
349 |
220 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
520 |
377 |
$7K |
| D2330 |
|
245 |
40 |
$5K |
| D2140 |
|
154 |
100 |
$3K |
| D1120 |
Prophylaxis - child |
179 |
149 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
109 |
$638.20 |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
13 |
$560.50 |
| D2999 |
|
21 |
21 |
$312.10 |