| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
938 |
801 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,558 |
763 |
$13K |
| D0272 |
Bitewings - two radiographic images |
859 |
735 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
767 |
650 |
$8K |
| D1999 |
|
579 |
547 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
465 |
390 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
480 |
400 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
947 |
809 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
208 |
100 |
$5K |
| D1120 |
Prophylaxis - child |
272 |
214 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
165 |
129 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
72 |
53 |
$2K |