| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,899 |
3,889 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,376 |
4,353 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,028 |
1,022 |
$22K |
| D1120 |
Prophylaxis - child |
615 |
614 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
285 |
230 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
968 |
966 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
383 |
380 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
205 |
205 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
204 |
172 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
521 |
517 |
$5K |