| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,550 |
3,895 |
$121K |
| D1999 |
|
6,023 |
5,273 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,672 |
3,443 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,832 |
2,399 |
$57K |
| D0272 |
Bitewings - two radiographic images |
3,526 |
3,016 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
3,429 |
2,955 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,407 |
2,030 |
$33K |
| D1120 |
Prophylaxis - child |
1,535 |
1,300 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,888 |
3,338 |
$28K |
| D2140 |
|
696 |
229 |
$20K |
| D1351 |
Sealant - per tooth |
683 |
89 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
263 |
118 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
231 |
88 |
$6K |
| D3120 |
|
106 |
63 |
$2K |
| D0270 |
|
43 |
43 |
$494.46 |