| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,098 |
1,098 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
352 |
248 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
476 |
348 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
515 |
514 |
$15K |
| D1110 |
Prophylaxis - adult |
185 |
185 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
355 |
355 |
$5K |
| D2160 |
|
50 |
40 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
26 |
$3K |
| D2140 |
|
46 |
37 |
$3K |
| D1120 |
Prophylaxis - child |
14 |
14 |
$612.75 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$192.00 |