| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,052 |
3,808 |
$109K |
| D1999 |
|
5,301 |
5,032 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
3,640 |
3,430 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,124 |
1,995 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,750 |
1,911 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,546 |
2,387 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
732 |
572 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,928 |
1,813 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,038 |
1,929 |
$16K |
| D1120 |
Prophylaxis - child |
886 |
845 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
565 |
535 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
139 |
117 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
17 |
$1K |