| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,205 |
1,790 |
$51K |
| D0272 |
Bitewings - two radiographic images |
1,825 |
1,520 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
902 |
467 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
998 |
603 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
2,011 |
1,612 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,481 |
1,193 |
$20K |
| D1120 |
Prophylaxis - child |
1,045 |
846 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,154 |
931 |
$16K |
| D2140 |
|
607 |
303 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,770 |
1,459 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,256 |
1,578 |
$9K |
| D2160 |
|
270 |
193 |
$8K |
| D2331 |
|
150 |
65 |
$5K |
| D1999 |
|
566 |
504 |
$4K |
| D2335 |
|
104 |
58 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
352 |
285 |
$4K |
| D2161 |
|
52 |
40 |
$2K |
| D2330 |
|
72 |
15 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
25 |
$1K |
| D7250 |
|
18 |
12 |
$675.60 |