| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
4,613 |
3,381 |
$152K |
| D0330 |
Panoramic radiographic image |
1,517 |
1,276 |
$69K |
| D1120 |
Prophylaxis - child |
2,297 |
1,914 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,182 |
935 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,319 |
1,937 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
461 |
253 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
139 |
87 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
233 |
54 |
$8K |
| D0272 |
Bitewings - two radiographic images |
198 |
179 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
217 |
180 |
$2K |
| D1110 |
Prophylaxis - adult |
16 |
15 |
$597.36 |