| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,556 |
614 |
$154K |
| D1110 |
Prophylaxis - adult |
2,380 |
2,363 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
2,149 |
2,131 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,011 |
1,004 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
717 |
717 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
228 |
186 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,247 |
1,246 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
957 |
951 |
$12K |
| D9110 |
|
192 |
185 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
483 |
482 |
$8K |
| D1120 |
Prophylaxis - child |
221 |
221 |
$8K |
| D2140 |
|
51 |
36 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
54 |
$2K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$638.30 |