| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,070 |
1,985 |
$52K |
| D1999 |
|
2,978 |
2,671 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,213 |
2,122 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,387 |
793 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,244 |
1,180 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
888 |
849 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,425 |
1,375 |
$10K |
| D1120 |
Prophylaxis - child |
516 |
500 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
398 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
157 |
113 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
119 |
116 |
$2K |
| D2140 |
|
78 |
50 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
39 |
$1K |
| D2940 |
|
33 |
28 |
$627.00 |