| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,505 |
3,455 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
5,139 |
5,090 |
$167K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,507 |
915 |
$140K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,440 |
1,099 |
$133K |
| D1206 |
Topical application of fluoride varnish |
4,499 |
4,450 |
$129K |
| D2140 |
|
1,524 |
1,023 |
$105K |
| D0272 |
Bitewings - two radiographic images |
2,235 |
2,199 |
$58K |
| D1120 |
Prophylaxis - child |
1,504 |
1,496 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
461 |
457 |
$12K |
| D2331 |
|
83 |
54 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
514 |
492 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
167 |
159 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
501 |
461 |
$5K |