| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,538 |
1,360 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
940 |
854 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,318 |
1,166 |
$20K |
| D1999 |
|
1,329 |
1,261 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,117 |
1,014 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,447 |
552 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,011 |
914 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
388 |
380 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
25 |
$4K |
| D1120 |
Prophylaxis - child |
148 |
146 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
24 |
$2K |
| D2140 |
|
15 |
13 |
$555.38 |