| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,389 |
1,294 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,280 |
1,195 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
687 |
634 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
294 |
160 |
$26K |
| D0272 |
Bitewings - two radiographic images |
976 |
904 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
655 |
591 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
293 |
273 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
53 |
$2K |
| D1120 |
Prophylaxis - child |
67 |
62 |
$2K |