| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,763 |
2,448 |
$80K |
| D1999 |
|
2,937 |
2,724 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,542 |
2,300 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
484 |
399 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,113 |
951 |
$16K |
| D0272 |
Bitewings - two radiographic images |
985 |
923 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
680 |
541 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,167 |
1,058 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,081 |
1,008 |
$8K |
| D1120 |
Prophylaxis - child |
217 |
191 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
81 |
61 |
$3K |
| D2140 |
|
38 |
27 |
$777.80 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$353.41 |
| D2940 |
|
13 |
12 |
$238.04 |