| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,279 |
5,275 |
$54K |
| D2140 |
|
1,603 |
839 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,698 |
1,194 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
1,767 |
1,766 |
$33K |
| D1110 |
Prophylaxis - adult |
2,506 |
2,506 |
$30K |
| D1120 |
Prophylaxis - child |
813 |
812 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
245 |
190 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,877 |
1,499 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,644 |
1,644 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
315 |
315 |
$2K |
| D0272 |
Bitewings - two radiographic images |
445 |
445 |
$2K |