| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
4,419 |
3,594 |
$65K |
| D1110 |
Prophylaxis - adult |
1,811 |
1,588 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
841 |
563 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,257 |
1,105 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
527 |
335 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,108 |
983 |
$16K |
| D0272 |
Bitewings - two radiographic images |
501 |
500 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
497 |
405 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
875 |
731 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
748 |
742 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
285 |
$5K |
| D1120 |
Prophylaxis - child |
162 |
135 |
$3K |
| D2160 |
|
54 |
45 |
$3K |
| D2140 |
|
45 |
26 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
13 |
$1K |