| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,007 |
836 |
$23K |
| D0272 |
Bitewings - two radiographic images |
813 |
662 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
876 |
712 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
465 |
373 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
346 |
283 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
175 |
109 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
136 |
80 |
$3K |
| D1120 |
Prophylaxis - child |
215 |
178 |
$3K |
| D1999 |
|
214 |
197 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
228 |
184 |
$1K |
| D2160 |
|
28 |
12 |
$854.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
102 |
75 |
$380.60 |