| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,263 |
2,202 |
$61K |
| D1999 |
|
2,625 |
2,489 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,710 |
1,658 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
666 |
467 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,999 |
1,952 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,219 |
1,181 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
240 |
235 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,318 |
1,276 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
732 |
704 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,159 |
574 |
$9K |
| D1120 |
Prophylaxis - child |
329 |
314 |
$6K |
| D2940 |
|
101 |
93 |
$3K |
| D2140 |
|
60 |
38 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
105 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
12 |
$526.50 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$464.46 |