| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,053 |
2,022 |
$91K |
| D7140 |
Extraction, erupted tooth or exposed root |
800 |
461 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,706 |
1,652 |
$67K |
| D1206 |
Topical application of fluoride varnish |
1,846 |
1,820 |
$54K |
| D2140 |
|
819 |
613 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
286 |
246 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
617 |
586 |
$22K |
| D1110 |
Prophylaxis - adult |
295 |
295 |
$19K |
| D0274 |
Bitewings - four radiographic images |
609 |
592 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
495 |
459 |
$13K |
| D0272 |
Bitewings - two radiographic images |
452 |
447 |
$7K |
| D0330 |
Panoramic radiographic image |
83 |
82 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
64 |
$588.76 |