| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,740 |
2,356 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,531 |
879 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,160 |
2,108 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,382 |
1,970 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,852 |
1,517 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,475 |
1,226 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,839 |
1,644 |
$19K |
| D2140 |
|
754 |
486 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
672 |
393 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,636 |
2,125 |
$15K |
| D1120 |
Prophylaxis - child |
851 |
709 |
$13K |
| D2160 |
|
206 |
162 |
$7K |
| D2330 |
|
106 |
58 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
117 |
$2K |
| D2331 |
|
20 |
14 |
$467.50 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$249.90 |