| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,599 |
2,430 |
$73K |
| D1999 |
|
3,160 |
2,827 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,927 |
1,792 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,824 |
1,708 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,668 |
2,081 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
799 |
732 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,062 |
1,908 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
308 |
225 |
$9K |
| D2140 |
|
299 |
181 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
158 |
91 |
$5K |
| D2330 |
|
104 |
68 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
199 |
180 |
$3K |
| D2160 |
|
41 |
33 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
52 |
$845.18 |
| D1120 |
Prophylaxis - child |
33 |
25 |
$568.00 |