| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,097 |
3,009 |
$80K |
| D1999 |
|
3,678 |
3,347 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,758 |
2,673 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,260 |
2,198 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,730 |
1,858 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
777 |
759 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
550 |
550 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
314 |
229 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,363 |
1,330 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
574 |
566 |
$8K |
| D1120 |
Prophylaxis - child |
110 |
110 |
$2K |
| D2160 |
|
42 |
39 |
$1K |
| D2335 |
|
29 |
25 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
40 |
$1K |
| D2140 |
|
54 |
38 |
$1K |