| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
987 |
807 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,051 |
723 |
$16K |
| D0272 |
Bitewings - two radiographic images |
866 |
706 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
846 |
708 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
551 |
453 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
442 |
361 |
$7K |
| D2140 |
|
317 |
151 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
957 |
773 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
183 |
95 |
$5K |
| D1120 |
Prophylaxis - child |
262 |
217 |
$4K |
| D1999 |
|
106 |
92 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
58 |
$823.46 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$642.88 |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$292.50 |