| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,684 |
4,442 |
$122K |
| D1999 |
|
4,826 |
4,481 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,856 |
3,686 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,955 |
2,794 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,022 |
3,229 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,559 |
1,455 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,253 |
3,066 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,154 |
1,077 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
321 |
225 |
$10K |
| D1120 |
Prophylaxis - child |
331 |
303 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
27 |
$2K |
| D2160 |
|
33 |
24 |
$2K |
| D2940 |
|
16 |
13 |
$285.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$79.74 |