| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,845 |
3,743 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
4,377 |
3,328 |
$60K |
| D0272 |
Bitewings - two radiographic images |
1,441 |
1,141 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,362 |
1,904 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,916 |
1,490 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
675 |
555 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
407 |
194 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
349 |
216 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
602 |
461 |
$9K |
| D2140 |
|
150 |
43 |
$4K |
| D1120 |
Prophylaxis - child |
170 |
118 |
$3K |
| D1999 |
|
160 |
150 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
79 |
$2K |
| D2160 |
|
29 |
13 |
$1K |
| D2330 |
|
19 |
12 |
$462.48 |