| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,111 |
4,021 |
$103K |
| D1999 |
|
5,598 |
5,010 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,068 |
3,590 |
$78K |
| D0272 |
Bitewings - two radiographic images |
3,628 |
3,543 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,337 |
2,310 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,796 |
2,715 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,846 |
3,748 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
541 |
440 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
555 |
468 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
909 |
884 |
$12K |
| D2140 |
|
427 |
326 |
$11K |
| D1120 |
Prophylaxis - child |
213 |
213 |
$4K |
| D2160 |
|
31 |
25 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
113 |
109 |
$1K |
| D2161 |
|
36 |
32 |
$1K |
| D2335 |
|
24 |
16 |
$830.50 |
| D9995 |
|
30 |
30 |
$420.00 |