| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,763 |
3,440 |
$103K |
| D1999 |
|
4,416 |
4,084 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
3,613 |
3,270 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,885 |
1,722 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,675 |
2,390 |
$38K |
| D1120 |
Prophylaxis - child |
1,616 |
1,445 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,930 |
1,471 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,607 |
1,467 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,887 |
1,755 |
$13K |
| D1351 |
Sealant - per tooth |
657 |
79 |
$10K |
| D2140 |
|
119 |
51 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
90 |
42 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
14 |
$613.46 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$443.44 |