| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,068 |
3,064 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
3,279 |
3,276 |
$79K |
| D1120 |
Prophylaxis - child |
1,076 |
1,076 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,323 |
1,315 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
920 |
332 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
657 |
651 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,076 |
1,073 |
$20K |
| D1206 |
Topical application of fluoride varnish |
755 |
755 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
292 |
292 |
$9K |
| D0330 |
Panoramic radiographic image |
188 |
188 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
297 |
297 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
596 |
576 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
40 |
$2K |
| D2330 |
|
14 |
12 |
$619.82 |
| D2140 |
|
13 |
13 |
$417.49 |