| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,034 |
2,474 |
$84K |
| D1999 |
|
4,750 |
3,535 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,664 |
2,191 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
880 |
481 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,368 |
1,980 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,393 |
2,108 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,424 |
2,019 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
731 |
579 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,090 |
916 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
243 |
170 |
$13K |
| D2140 |
|
118 |
75 |
$4K |
| D2160 |
|
45 |
25 |
$2K |
| D1120 |
Prophylaxis - child |
141 |
131 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
17 |
17 |
$0.00 |