| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
789 |
723 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,142 |
1,059 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
894 |
836 |
$12K |
| D1120 |
Prophylaxis - child |
648 |
609 |
$12K |
| D1999 |
|
790 |
733 |
$11K |
| D0272 |
Bitewings - two radiographic images |
733 |
678 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
835 |
778 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
977 |
774 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
182 |
140 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
136 |
95 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
252 |
240 |
$4K |
| D2140 |
|
176 |
130 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
59 |
$698.16 |