| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,400 |
2,396 |
$28K |
| D2160 |
|
734 |
424 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,430 |
1,426 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,321 |
1,317 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,766 |
1,764 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
2,240 |
2,203 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
238 |
124 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
177 |
112 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,470 |
1,457 |
$4K |
| D2332 |
|
48 |
29 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
188 |
$2K |
| D9110 |
|
116 |
114 |
$998.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
82 |
82 |
$608.00 |
| D1120 |
Prophylaxis - child |
24 |
24 |
$234.00 |