| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,419 |
2,273 |
$69K |
| D1999 |
|
3,287 |
2,978 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,122 |
2,014 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,566 |
1,445 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
584 |
358 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
920 |
840 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
691 |
607 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
319 |
197 |
$10K |
| D1120 |
Prophylaxis - child |
461 |
401 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,058 |
956 |
$7K |
| D2140 |
|
234 |
141 |
$6K |
| D2160 |
|
124 |
88 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
446 |
379 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
134 |
117 |
$2K |