| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,110 |
4,668 |
$137K |
| D0210 |
Intraoral - complete series of radiographic images |
2,343 |
2,109 |
$102K |
| D1999 |
|
5,680 |
5,305 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
4,608 |
4,255 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,706 |
1,528 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,220 |
2,037 |
$31K |
| D1120 |
Prophylaxis - child |
1,049 |
989 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,065 |
990 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
132 |
99 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
52 |
$3K |
| D2140 |
|
35 |
28 |
$747.00 |
| D9110 |
|
12 |
12 |
$52.50 |