| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,456 |
2,244 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,386 |
3,088 |
$65K |
| D0330 |
Panoramic radiographic image |
1,342 |
1,209 |
$65K |
| D1120 |
Prophylaxis - child |
1,176 |
1,080 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
728 |
664 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,164 |
1,078 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,471 |
1,356 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
762 |
689 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
24 |
$15K |
| D1206 |
Topical application of fluoride varnish |
201 |
173 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
16 |
$2K |
| D2140 |
|
16 |
12 |
$1K |
| D1999 |
|
48 |
45 |
$10.00 |