| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,327 |
2,827 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,195 |
2,093 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
3,415 |
2,893 |
$43K |
| D1999 |
|
2,932 |
2,573 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,722 |
2,329 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,265 |
1,901 |
$32K |
| D1120 |
Prophylaxis - child |
1,348 |
1,099 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,137 |
948 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,441 |
2,090 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
205 |
128 |
$5K |
| D2140 |
|
200 |
122 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
28 |
$855.95 |