| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
556 |
542 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
518 |
504 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
187 |
124 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
158 |
117 |
$3K |
| D0272 |
Bitewings - two radiographic images |
254 |
249 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
244 |
243 |
$3K |
| D2160 |
|
88 |
71 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
479 |
467 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
634 |
329 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
179 |
176 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
137 |
133 |
$2K |
| D2335 |
|
43 |
27 |
$2K |
| D1120 |
Prophylaxis - child |
83 |
83 |
$1K |
| D2161 |
|
36 |
29 |
$1K |
| D2940 |
|
47 |
46 |
$791.00 |
| D1999 |
|
165 |
135 |
$0.00 |