| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,444 |
1,168 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,209 |
1,213 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,878 |
1,491 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
771 |
410 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,397 |
1,137 |
$19K |
| D1120 |
Prophylaxis - child |
1,093 |
853 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,221 |
942 |
$16K |
| D1999 |
|
914 |
795 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
718 |
575 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
435 |
235 |
$10K |
| D2160 |
|
288 |
182 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,491 |
1,209 |
$8K |
| D2140 |
|
376 |
233 |
$8K |
| D1351 |
Sealant - per tooth |
460 |
57 |
$6K |
| D2940 |
|
49 |
24 |
$731.50 |