| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,961 |
1,502 |
$69K |
| D1999 |
|
2,832 |
2,148 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,455 |
1,021 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,343 |
1,013 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
783 |
700 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
625 |
480 |
$9K |
| D1120 |
Prophylaxis - child |
276 |
214 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
677 |
488 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
118 |
85 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
269 |
197 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
578 |
460 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
43 |
$3K |
| D2140 |
|
18 |
13 |
$714.06 |