| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,968 |
3,268 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,952 |
3,697 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,520 |
1,599 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,172 |
3,492 |
$81K |
| D1999 |
|
4,420 |
3,634 |
$66K |
| D0272 |
Bitewings - two radiographic images |
3,929 |
3,265 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,402 |
3,662 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,680 |
1,322 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,660 |
1,377 |
$22K |
| D1120 |
Prophylaxis - child |
749 |
591 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
189 |
119 |
$6K |
| D2160 |
|
16 |
14 |
$912.74 |
| D0140 |
Limited oral evaluation - problem focused |
52 |
50 |
$710.78 |
| D2140 |
|
25 |
12 |
$540.00 |