| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
536 |
524 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
509 |
495 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
665 |
655 |
$7K |
| D0272 |
Bitewings - two radiographic images |
437 |
436 |
$6K |
| D1120 |
Prophylaxis - child |
362 |
353 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
225 |
154 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
336 |
332 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
257 |
245 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
117 |
92 |
$3K |
| D2140 |
|
142 |
91 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
389 |
388 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$207.84 |