| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,593 |
2,288 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,192 |
2,693 |
$52K |
| D1999 |
|
3,415 |
3,102 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
518 |
323 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,845 |
1,591 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,966 |
1,653 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
769 |
346 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,675 |
1,523 |
$21K |
| D7220 |
|
219 |
108 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
862 |
454 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,016 |
2,603 |
$19K |
| D7250 |
|
205 |
110 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
645 |
510 |
$8K |
| D2160 |
|
103 |
55 |
$4K |
| D1120 |
Prophylaxis - child |
245 |
189 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
198 |
163 |
$3K |
| D2140 |
|
85 |
47 |
$2K |