| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,058 |
2,662 |
$167K |
| D1110 |
Prophylaxis - adult |
5,443 |
5,105 |
$140K |
| D1999 |
|
8,565 |
6,753 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
5,964 |
5,598 |
$73K |
| D0272 |
Bitewings - two radiographic images |
3,940 |
3,693 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,811 |
2,625 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
2,608 |
2,406 |
$42K |
| D2140 |
|
1,402 |
939 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,048 |
762 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,462 |
1,343 |
$20K |
| D2160 |
|
420 |
353 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,017 |
1,894 |
$14K |
| D1120 |
Prophylaxis - child |
605 |
544 |
$10K |
| D2335 |
|
117 |
73 |
$4K |
| D9110 |
|
122 |
120 |
$2K |
| D0330 |
Panoramic radiographic image |
20 |
17 |
$612.16 |
| D2332 |
|
16 |
15 |
$580.12 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
24 |
$171.10 |