| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,277 |
3,744 |
$197K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,114 |
680 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
4,575 |
4,260 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,739 |
2,250 |
$118K |
| D1120 |
Prophylaxis - child |
2,481 |
2,467 |
$85K |
| D0272 |
Bitewings - two radiographic images |
2,403 |
2,380 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,528 |
2,508 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,047 |
831 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,796 |
1,464 |
$22K |
| D1206 |
Topical application of fluoride varnish |
308 |
308 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
122 |
84 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
29 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
317 |
212 |
$3K |
| D2140 |
|
37 |
18 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$270.75 |