| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,767 |
3,574 |
$98K |
| D1999 |
|
4,382 |
3,932 |
$63K |
| D0272 |
Bitewings - two radiographic images |
3,433 |
3,236 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
3,687 |
3,507 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,542 |
3,962 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,141 |
1,978 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,719 |
3,495 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,138 |
1,051 |
$21K |
| D1120 |
Prophylaxis - child |
1,009 |
944 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
834 |
766 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
248 |
176 |
$7K |
| D2140 |
|
167 |
120 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
111 |
68 |
$3K |
| D2940 |
|
14 |
13 |
$226.00 |