| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,529 |
2,126 |
$70K |
| D1999 |
|
3,270 |
2,940 |
$46K |
| D2140 |
|
1,072 |
543 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
665 |
470 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,601 |
1,375 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,633 |
1,376 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,113 |
1,058 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
951 |
824 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
532 |
472 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
190 |
144 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
962 |
823 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
122 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
50 |
$1K |
| D2330 |
|
37 |
13 |
$819.69 |