| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
436 |
392 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
295 |
156 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
172 |
142 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
425 |
388 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
258 |
232 |
$3K |
| D0272 |
Bitewings - two radiographic images |
259 |
241 |
$3K |
| D1120 |
Prophylaxis - child |
152 |
140 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
161 |
140 |
$2K |
| D2140 |
|
103 |
55 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
53 |
$2K |
| D2160 |
|
39 |
25 |
$965.20 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
31 |
$194.40 |