| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,727 |
2,411 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,370 |
2,080 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,868 |
1,647 |
$26K |
| D1999 |
|
1,424 |
1,276 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,289 |
1,000 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
575 |
453 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
207 |
138 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
336 |
284 |
$6K |
| D2140 |
|
124 |
63 |
$3K |
| D1120 |
Prophylaxis - child |
183 |
142 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
85 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
38 |
$987.82 |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
50 |
$376.20 |
| D2940 |
|
14 |
13 |
$240.54 |