| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,990 |
3,990 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
4,848 |
4,846 |
$94K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,217 |
932 |
$91K |
| D2160 |
|
555 |
439 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,281 |
3,280 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
1,026 |
1,026 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,897 |
2,896 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,637 |
2,635 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
564 |
564 |
$6K |
| D1120 |
Prophylaxis - child |
200 |
200 |
$6K |
| D4341 |
|
74 |
39 |
$5K |
| D2140 |
|
76 |
68 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
14 |
$540.88 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$248.00 |
| D1999 |
|
166 |
143 |
$0.00 |