| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
546 |
542 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
782 |
778 |
$24K |
| D0274 |
Bitewings - four radiographic images |
397 |
395 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
117 |
73 |
$9K |
| D2140 |
|
91 |
53 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
52 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
110 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
14 |
14 |
$522.82 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$360.96 |