| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,573 |
5,622 |
$174K |
| D1999 |
|
8,567 |
6,728 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,082 |
3,539 |
$86K |
| D0272 |
Bitewings - two radiographic images |
5,372 |
4,600 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,799 |
3,259 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,375 |
2,115 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
311 |
218 |
$17K |
| D1120 |
Prophylaxis - child |
952 |
892 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,012 |
1,559 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
734 |
669 |
$12K |
| D2140 |
|
346 |
220 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
782 |
386 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
133 |
94 |
$6K |
| D1351 |
Sealant - per tooth |
115 |
13 |
$1K |
| D2160 |
|
13 |
13 |
$757.05 |