| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
14,487 |
13,711 |
$381K |
| D1999 |
|
12,722 |
11,832 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
12,024 |
11,268 |
$165K |
| D0272 |
Bitewings - two radiographic images |
10,204 |
9,704 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,438 |
5,300 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,831 |
5,545 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,480 |
1,032 |
$60K |
| D1120 |
Prophylaxis - child |
2,389 |
2,281 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,025 |
792 |
$32K |
| D2160 |
|
769 |
647 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,899 |
1,805 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
675 |
511 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
95 |
86 |
$1K |
| D2161 |
|
13 |
13 |
$476.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
13 |
$456.30 |