| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,371 |
2,057 |
$59K |
| D0272 |
Bitewings - two radiographic images |
1,444 |
1,236 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,432 |
1,213 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
993 |
859 |
$15K |
| D1999 |
|
831 |
742 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
350 |
209 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
635 |
533 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
286 |
206 |
$6K |
| D2140 |
|
216 |
148 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
759 |
643 |
$4K |
| D1120 |
Prophylaxis - child |
129 |
110 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
280 |
172 |
$972.14 |
| D0140 |
Limited oral evaluation - problem focused |
47 |
41 |
$618.46 |