| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,862 |
4,835 |
$164K |
| D1999 |
|
8,063 |
6,785 |
$118K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,449 |
1,562 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,901 |
3,154 |
$77K |
| D2140 |
|
2,371 |
1,303 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
3,905 |
3,292 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,218 |
2,639 |
$45K |
| D0272 |
Bitewings - two radiographic images |
3,021 |
2,503 |
$44K |
| D2160 |
|
990 |
717 |
$40K |
| D1120 |
Prophylaxis - child |
1,826 |
1,511 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
750 |
547 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,320 |
1,109 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
472 |
401 |
$8K |
| D2330 |
|
196 |
115 |
$5K |
| D2335 |
|
42 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
277 |
193 |
$1K |