| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,609 |
1,394 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,794 |
1,572 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,029 |
907 |
$15K |
| D1120 |
Prophylaxis - child |
600 |
526 |
$10K |
| D1999 |
|
553 |
504 |
$9K |
| D0272 |
Bitewings - two radiographic images |
406 |
330 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
360 |
293 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
946 |
276 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
95 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
430 |
346 |
$2K |
| D2140 |
|
96 |
60 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
57 |
32 |
$1K |
| D1351 |
Sealant - per tooth |
41 |
12 |
$553.50 |