| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,312 |
2,889 |
$84K |
| D1999 |
|
2,772 |
2,294 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
2,950 |
2,584 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,213 |
1,032 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,344 |
1,099 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
351 |
265 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
374 |
317 |
$15K |
| D2140 |
|
440 |
266 |
$11K |
| D1120 |
Prophylaxis - child |
530 |
434 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
171 |
122 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
68 |
49 |
$390.86 |