| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
758 |
670 |
$11K |
| D1110 |
Prophylaxis - adult |
427 |
410 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,475 |
340 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
425 |
409 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
510 |
480 |
$4K |
| D0272 |
Bitewings - two radiographic images |
268 |
260 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
33 |
$967.50 |
| D2140 |
|
30 |
25 |
$879.45 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$480.12 |
| D2330 |
|
24 |
14 |
$433.50 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
14 |
$397.20 |
| D1208 |
Topical application of fluoride, excluding varnish |
24 |
24 |
$325.13 |