| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,591 |
1,335 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,173 |
600 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,508 |
1,255 |
$19K |
| D2160 |
|
490 |
307 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,047 |
860 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
1,130 |
951 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,760 |
1,672 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
810 |
671 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,745 |
1,436 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
395 |
244 |
$9K |
| D1120 |
Prophylaxis - child |
537 |
443 |
$8K |
| D2940 |
|
262 |
185 |
$5K |
| D2140 |
|
191 |
139 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
263 |
201 |
$3K |
| D1999 |
|
337 |
293 |
$2K |
| D3310 |
|
13 |
12 |
$2K |
| D2331 |
|
36 |
28 |
$1K |