| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9420 |
|
802 |
800 |
$60K |
| D1110 |
Prophylaxis - adult |
735 |
733 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
803 |
798 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
632 |
632 |
$17K |
| D0274 |
Bitewings - four radiographic images |
353 |
353 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
563 |
563 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
120 |
117 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
25 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
13 |
$2K |
| D2140 |
|
24 |
12 |
$1K |