| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,999 |
4,298 |
$144K |
| D0210 |
Intraoral - complete series of radiographic images |
2,051 |
1,849 |
$92K |
| D1999 |
|
5,902 |
4,889 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,691 |
1,010 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,486 |
2,232 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
3,521 |
2,941 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
767 |
351 |
$28K |
| D2140 |
|
868 |
351 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,856 |
1,606 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,410 |
1,176 |
$21K |
| D1120 |
Prophylaxis - child |
772 |
650 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$37.85 |