| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,795 |
2,426 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
1,837 |
1,532 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,169 |
1,038 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,302 |
1,150 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,317 |
1,597 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,856 |
1,595 |
$11K |
| D1999 |
|
693 |
609 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
359 |
203 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
432 |
340 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
195 |
163 |
$3K |
| D2140 |
|
76 |
40 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
55 |
29 |
$1K |
| D1120 |
Prophylaxis - child |
93 |
71 |
$1K |