| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,327 |
2,173 |
$60K |
| D1999 |
|
3,742 |
3,156 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,146 |
1,073 |
$24K |
| D2140 |
|
682 |
429 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,458 |
1,369 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
406 |
288 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,253 |
1,170 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,282 |
1,715 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,911 |
1,785 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
446 |
420 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
53 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
72 |
$1K |
| D1120 |
Prophylaxis - child |
49 |
44 |
$896.00 |