| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,595 |
3,964 |
$128K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,628 |
1,423 |
$96K |
| D1999 |
|
5,039 |
4,438 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
4,693 |
4,005 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,457 |
883 |
$48K |
| D0272 |
Bitewings - two radiographic images |
3,192 |
2,900 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,270 |
1,939 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,437 |
2,914 |
$29K |
| D2140 |
|
931 |
590 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,148 |
1,008 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
3,118 |
2,814 |
$22K |
| D1120 |
Prophylaxis - child |
1,111 |
930 |
$20K |
| D2160 |
|
503 |
363 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
21 |
21 |
$403.69 |