| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,908 |
1,841 |
$49K |
| D1999 |
|
2,387 |
2,127 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,454 |
1,392 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,048 |
1,009 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
718 |
699 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
413 |
398 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
168 |
105 |
$5K |
| D2140 |
|
156 |
83 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
46 |
$1K |
| D1120 |
Prophylaxis - child |
77 |
77 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
40 |
$266.04 |