| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,598 |
2,970 |
$96K |
| D1999 |
|
3,886 |
3,330 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,691 |
2,212 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,740 |
1,431 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,609 |
1,292 |
$22K |
| D1120 |
Prophylaxis - child |
613 |
474 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
473 |
402 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
137 |
97 |
$5K |
| D2140 |
|
202 |
132 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
79 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
434 |
371 |
$3K |
| D0272 |
Bitewings - two radiographic images |
20 |
20 |
$278.80 |
| D2940 |
|
15 |
12 |
$260.12 |