| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
13,254 |
10,265 |
$349K |
| D0120 |
Periodic oral evaluation - established patient |
11,541 |
8,844 |
$164K |
| D0272 |
Bitewings - two radiographic images |
7,694 |
5,982 |
$109K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,478 |
913 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,976 |
7,381 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,761 |
2,957 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
9,367 |
7,247 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,775 |
2,917 |
$53K |
| D1999 |
|
2,657 |
2,626 |
$41K |
| D1120 |
Prophylaxis - child |
1,533 |
1,165 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,435 |
1,173 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
466 |
311 |
$17K |
| D2140 |
|
215 |
170 |
$6K |
| D2160 |
|
14 |
12 |
$355.20 |