| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,123 |
2,114 |
$72K |
| D1110 |
Prophylaxis - adult |
1,243 |
1,239 |
$50K |
| D1120 |
Prophylaxis - child |
840 |
836 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
374 |
184 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
864 |
863 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
334 |
330 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
735 |
706 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
322 |
322 |
$7K |
| D2161 |
|
70 |
52 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
101 |
78 |
$7K |
| D0272 |
Bitewings - two radiographic images |
245 |
245 |
$5K |
| D2332 |
|
28 |
16 |
$3K |
| D2160 |
|
31 |
25 |
$3K |
| D2140 |
|
41 |
33 |
$2K |
| D9110 |
|
13 |
12 |
$675.24 |