| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,264 |
1,087 |
$32K |
| D1999 |
|
1,431 |
1,244 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,291 |
725 |
$11K |
| D0272 |
Bitewings - two radiographic images |
731 |
593 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
713 |
640 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
494 |
376 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
858 |
704 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
110 |
72 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
170 |
139 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$630.00 |
| D2140 |
|
20 |
12 |
$432.00 |
| D1120 |
Prophylaxis - child |
26 |
25 |
$405.00 |