| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,169 |
5,692 |
$195K |
| D1999 |
|
7,758 |
6,297 |
$114K |
| D0330 |
Panoramic radiographic image |
3,813 |
3,087 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
6,888 |
5,500 |
$92K |
| D0272 |
Bitewings - two radiographic images |
6,470 |
5,219 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,638 |
2,110 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,201 |
2,527 |
$44K |
| D1120 |
Prophylaxis - child |
2,061 |
1,622 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
746 |
421 |
$27K |
| D1351 |
Sealant - per tooth |
1,032 |
100 |
$15K |
| D2160 |
|
289 |
175 |
$14K |
| D2140 |
|
253 |
133 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
77 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
14 |
$774.80 |
| D2335 |
|
17 |
12 |
$590.00 |
| D2161 |
|
13 |
12 |
$452.70 |