| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,096 |
875 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
940 |
742 |
$10K |
| D0272 |
Bitewings - two radiographic images |
588 |
470 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
631 |
508 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
209 |
156 |
$3K |
| D2330 |
|
109 |
41 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
136 |
120 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
42 |
$1K |
| D2140 |
|
28 |
24 |
$604.36 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
13 |
$374.00 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$194.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
14 |
$50.30 |