| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,647 |
7,484 |
$229K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,309 |
6,543 |
$175K |
| D1999 |
|
8,944 |
7,256 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,203 |
4,538 |
$111K |
| D0272 |
Bitewings - two radiographic images |
7,140 |
6,181 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
5,451 |
4,679 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
7,561 |
6,550 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,248 |
2,819 |
$46K |
| D1120 |
Prophylaxis - child |
1,531 |
1,357 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
336 |
228 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
335 |
211 |
$10K |
| D2140 |
|
328 |
196 |
$8K |
| D2330 |
|
53 |
12 |
$1K |