| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,134 |
992 |
$26K |
| D1999 |
|
1,206 |
1,115 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,305 |
1,115 |
$18K |
| D0272 |
Bitewings - two radiographic images |
792 |
695 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
775 |
665 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
692 |
637 |
$9K |
| D1120 |
Prophylaxis - child |
396 |
334 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
916 |
826 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
799 |
625 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
68 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
319 |
269 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
16 |
$1K |
| D9995 |
|
16 |
16 |
$210.00 |