| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,196 |
2,683 |
$83K |
| D1999 |
|
3,130 |
2,741 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,997 |
1,806 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
2,639 |
2,222 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,205 |
1,880 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,344 |
1,138 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,477 |
1,213 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,253 |
1,923 |
$15K |
| D1120 |
Prophylaxis - child |
624 |
495 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
256 |
167 |
$8K |
| D2140 |
|
34 |
25 |
$1K |
| D2160 |
|
14 |
12 |
$424.40 |