| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
828 |
689 |
$12K |
| D1110 |
Prophylaxis - adult |
276 |
273 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
758 |
258 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
124 |
95 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
59 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
157 |
155 |
$4K |
| D0272 |
Bitewings - two radiographic images |
234 |
231 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
174 |
174 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
281 |
276 |
$2K |
| D2161 |
|
21 |
20 |
$1K |
| D2140 |
|
36 |
30 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
96 |
96 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
60 |
$1K |
| D1120 |
Prophylaxis - child |
41 |
41 |
$943.00 |
| D2160 |
|
16 |
14 |
$933.60 |