| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
644 |
529 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
169 |
105 |
$6K |
| D2140 |
|
243 |
134 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
481 |
398 |
$5K |
| D1999 |
|
348 |
334 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
265 |
192 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
268 |
192 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
110 |
58 |
$3K |
| D1120 |
Prophylaxis - child |
120 |
74 |
$2K |
| D0330 |
Panoramic radiographic image |
45 |
45 |
$1K |
| D0272 |
Bitewings - two radiographic images |
62 |
62 |
$883.07 |
| D0140 |
Limited oral evaluation - problem focused |
38 |
25 |
$458.40 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$336.50 |