| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,109 |
905 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
281 |
260 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
93 |
69 |
$2K |
| D1120 |
Prophylaxis - child |
180 |
168 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
37 |
36 |
$2K |
| D1206 |
Topical application of fluoride varnish |
112 |
102 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
30 |
$752.36 |
| D0274 |
Bitewings - four radiographic images |
32 |
32 |
$446.44 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$355.27 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$0.00 |