| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,773 |
2,583 |
$79K |
| D1999 |
|
4,102 |
3,778 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,445 |
2,286 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,387 |
1,268 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
634 |
559 |
$13K |
| D1120 |
Prophylaxis - child |
413 |
369 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
433 |
387 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
189 |
140 |
$6K |
| D2140 |
|
106 |
77 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
54 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
68 |
64 |
$552.40 |
| D0272 |
Bitewings - two radiographic images |
21 |
21 |
$285.18 |