| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,649 |
4,149 |
$132K |
| D1999 |
|
5,406 |
4,692 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
3,936 |
3,496 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,752 |
2,486 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,563 |
1,434 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,640 |
1,474 |
$24K |
| D1120 |
Prophylaxis - child |
817 |
743 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
641 |
614 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
84 |
69 |
$3K |
| D2140 |
|
66 |
54 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
51 |
$878.88 |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
50 |
$452.66 |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$401.90 |