| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,599 |
2,377 |
$72K |
| D1999 |
|
4,028 |
3,514 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,200 |
1,981 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
641 |
444 |
$24K |
| D2140 |
|
790 |
443 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
530 |
380 |
$17K |
| D0272 |
Bitewings - two radiographic images |
873 |
797 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
658 |
619 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
674 |
637 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
646 |
578 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
599 |
556 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
416 |
380 |
$2K |
| D1120 |
Prophylaxis - child |
110 |
78 |
$2K |
| D2331 |
|
17 |
13 |
$827.21 |