| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,633 |
3,853 |
$121K |
| D1999 |
|
6,051 |
5,334 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,365 |
1,429 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,283 |
2,837 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
4,608 |
3,835 |
$61K |
| D2140 |
|
1,745 |
770 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,402 |
2,011 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,938 |
2,538 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,706 |
2,182 |
$38K |
| D1120 |
Prophylaxis - child |
1,811 |
1,459 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,993 |
2,588 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
868 |
738 |
$14K |
| D3120 |
|
713 |
536 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
375 |
243 |
$12K |
| D2335 |
|
19 |
13 |
$760.50 |
| D2160 |
|
13 |
13 |
$737.87 |
| D9110 |
|
13 |
13 |
$305.70 |