| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,795 |
3,500 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
3,741 |
3,461 |
$47K |
| D2140 |
|
722 |
507 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,314 |
1,194 |
$19K |
| D1999 |
|
1,066 |
944 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
487 |
387 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
963 |
859 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
473 |
399 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
932 |
819 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
106 |
$5K |
| D2330 |
|
120 |
80 |
$4K |
| D1120 |
Prophylaxis - child |
222 |
170 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
169 |
135 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
24 |
$124.00 |