| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
567 |
265 |
$37K |
| D1110 |
Prophylaxis - adult |
947 |
941 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,196 |
1,186 |
$26K |
| D0330 |
Panoramic radiographic image |
418 |
411 |
$17K |
| D1120 |
Prophylaxis - child |
411 |
407 |
$14K |
| D0272 |
Bitewings - two radiographic images |
673 |
665 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
542 |
536 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
130 |
97 |
$8K |
| D2140 |
|
121 |
81 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
265 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
351 |
344 |
$3K |
| D2332 |
|
20 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
49 |
49 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$123.35 |