| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,195 |
3,953 |
$116K |
| D1999 |
|
3,508 |
3,289 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
3,555 |
3,345 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,561 |
2,426 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,589 |
2,854 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,847 |
2,699 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
510 |
494 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
117 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
138 |
133 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
78 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
13 |
$579.12 |
| D2140 |
|
14 |
12 |
$288.28 |