| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,959 |
1,544 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,142 |
568 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,633 |
1,323 |
$23K |
| D2140 |
|
847 |
415 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,443 |
1,174 |
$18K |
| D2160 |
|
448 |
264 |
$16K |
| D1999 |
|
995 |
859 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
652 |
539 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
481 |
388 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
441 |
366 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
39 |
$2K |
| D1120 |
Prophylaxis - child |
98 |
68 |
$2K |
| D0330 |
Panoramic radiographic image |
60 |
60 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
157 |
73 |
$639.30 |
| D2940 |
|
21 |
12 |
$381.00 |