| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,858 |
2,770 |
$70K |
| D1999 |
|
2,873 |
2,649 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
3,135 |
3,043 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,596 |
1,862 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
812 |
611 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
961 |
930 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,996 |
1,936 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
194 |
168 |
$6K |
| D2140 |
|
167 |
121 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
302 |
294 |
$4K |
| D1120 |
Prophylaxis - child |
140 |
130 |
$2K |