| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,572 |
1,440 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,131 |
1,031 |
$16K |
| D1999 |
|
1,160 |
1,048 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
953 |
857 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,776 |
1,330 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
562 |
503 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,315 |
1,167 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
304 |
272 |
$4K |
| D2160 |
|
126 |
73 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
175 |
115 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
125 |
64 |
$3K |
| D1120 |
Prophylaxis - child |
149 |
135 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
112 |
88 |
$1K |
| D2140 |
|
18 |
12 |
$345.60 |
| D2940 |
|
17 |
13 |
$305.00 |