| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
5,758 |
4,451 |
$85K |
| D1110 |
Prophylaxis - adult |
2,379 |
1,887 |
$71K |
| D2140 |
|
1,581 |
498 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,194 |
1,910 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,267 |
966 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,592 |
1,257 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,465 |
1,162 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,066 |
1,662 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
347 |
189 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
644 |
511 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
591 |
449 |
$8K |
| D1120 |
Prophylaxis - child |
301 |
224 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
68 |
$5K |