| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,432 |
2,168 |
$63K |
| D1999 |
|
2,083 |
1,751 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,066 |
1,493 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,470 |
1,273 |
$19K |
| D2140 |
|
677 |
297 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
747 |
676 |
$14K |
| D0272 |
Bitewings - two radiographic images |
947 |
835 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
392 |
231 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,621 |
1,451 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
102 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
250 |
204 |
$3K |
| D1120 |
Prophylaxis - child |
25 |
24 |
$420.00 |