| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
4,900 |
4,311 |
$60K |
| D1110 |
Prophylaxis - adult |
1,902 |
1,604 |
$48K |
| D8670 |
Periodic orthodontic treatment visit |
1,451 |
1,295 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,470 |
1,250 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
697 |
573 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
729 |
596 |
$10K |
| D2140 |
|
308 |
131 |
$8K |
| D0272 |
Bitewings - two radiographic images |
410 |
302 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
317 |
272 |
$5K |
| D1120 |
Prophylaxis - child |
290 |
220 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
703 |
514 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
49 |
$3K |
| D0330 |
Panoramic radiographic image |
78 |
77 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
53 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
492 |
326 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
13 |
$758.97 |