| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
858 |
669 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
860 |
663 |
$8K |
| D0272 |
Bitewings - two radiographic images |
483 |
343 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
384 |
298 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
361 |
309 |
$5K |
| D1120 |
Prophylaxis - child |
275 |
212 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
161 |
91 |
$4K |
| D0330 |
Panoramic radiographic image |
128 |
120 |
$3K |
| D2140 |
|
89 |
59 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
208 |
93 |
$696.20 |