| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,060 |
2,937 |
$81K |
| D1999 |
|
3,573 |
3,385 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
3,613 |
3,494 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,597 |
2,649 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,304 |
2,203 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,303 |
2,218 |
$32K |
| D1120 |
Prophylaxis - child |
1,378 |
1,330 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,677 |
2,560 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
763 |
707 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
289 |
224 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
318 |
208 |
$10K |
| D2140 |
|
92 |
73 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$558.61 |