| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2140 |
|
1,323 |
437 |
$32K |
| D1110 |
Prophylaxis - adult |
1,143 |
953 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
789 |
357 |
$23K |
| D2335 |
|
289 |
88 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
726 |
568 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
809 |
713 |
$9K |
| D1999 |
|
531 |
480 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,111 |
430 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
494 |
404 |
$7K |
| D0272 |
Bitewings - two radiographic images |
426 |
358 |
$6K |
| D2160 |
|
149 |
77 |
$5K |
| D1120 |
Prophylaxis - child |
284 |
234 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
528 |
449 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$833.21 |