| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,814 |
3,660 |
$105K |
| D1999 |
|
4,503 |
4,293 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
3,949 |
3,804 |
$54K |
| D0272 |
Bitewings - two radiographic images |
3,128 |
3,001 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,164 |
2,071 |
$31K |
| D1120 |
Prophylaxis - child |
1,046 |
1,010 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
809 |
759 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,543 |
1,480 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
458 |
443 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
171 |
115 |
$6K |
| D2140 |
|
177 |
133 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
124 |
93 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
141 |
115 |
$2K |