| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,638 |
5,388 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
6,197 |
5,016 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,105 |
650 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,063 |
1,639 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,687 |
2,149 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
940 |
794 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,953 |
2,317 |
$38K |
| D1120 |
Prophylaxis - child |
1,475 |
1,135 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,437 |
1,156 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
413 |
240 |
$15K |
| D1999 |
|
630 |
460 |
$13K |
| D9995 |
|
683 |
601 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
946 |
795 |
$7K |
| D2140 |
|
149 |
57 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
147 |
104 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
42 |
40 |
$35.00 |