| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,318 |
5,037 |
$141K |
| D1999 |
|
8,982 |
8,152 |
$134K |
| D2140 |
|
4,026 |
2,345 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,546 |
4,730 |
$106K |
| D0272 |
Bitewings - two radiographic images |
4,576 |
4,346 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,413 |
1,091 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,269 |
981 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
4,062 |
3,875 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,590 |
2,425 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
5,414 |
5,122 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,374 |
2,248 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,614 |
1,537 |
$28K |
| D1120 |
Prophylaxis - child |
1,169 |
1,103 |
$21K |
| D2940 |
|
387 |
354 |
$10K |
| D2330 |
|
72 |
49 |
$2K |