| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,932 |
5,013 |
$150K |
| D1999 |
|
7,259 |
5,870 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
6,103 |
5,194 |
$82K |
| D0272 |
Bitewings - two radiographic images |
4,786 |
4,049 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,852 |
4,754 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,347 |
2,812 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,015 |
1,645 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,650 |
3,911 |
$34K |
| D1120 |
Prophylaxis - child |
1,896 |
1,606 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
753 |
548 |
$26K |
| D2140 |
|
220 |
166 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
194 |
154 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
325 |
298 |
$4K |