| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,393 |
1,165 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
502 |
306 |
$13K |
| D0272 |
Bitewings - two radiographic images |
913 |
758 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
698 |
606 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
996 |
821 |
$10K |
| D2160 |
|
294 |
197 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
587 |
496 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
940 |
771 |
$5K |
| D1120 |
Prophylaxis - child |
306 |
266 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
119 |
119 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,185 |
837 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
67 |
$2K |
| D2140 |
|
87 |
61 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
30 |
$1K |
| D1999 |
|
29 |
26 |
$377.26 |