| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
768 |
765 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,111 |
1,109 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,370 |
2,061 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,621 |
2,512 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
237 |
236 |
$13K |
| D1120 |
Prophylaxis - child |
346 |
340 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
134 |
96 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
120 |
63 |
$7K |
| D2330 |
|
66 |
29 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
291 |
289 |
$2K |
| D2140 |
|
25 |
12 |
$1K |
| D9110 |
|
13 |
13 |
$693.00 |