| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,263 |
1,080 |
$36K |
| D1999 |
|
2,580 |
2,138 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,429 |
1,220 |
$20K |
| D0272 |
Bitewings - two radiographic images |
664 |
579 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
211 |
163 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
498 |
438 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
494 |
120 |
$3K |
| D1120 |
Prophylaxis - child |
175 |
138 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
57 |
29 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
102 |
102 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
72 |
71 |
$521.02 |