| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
709 |
627 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
340 |
202 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
897 |
792 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
210 |
65 |
$15K |
| D0272 |
Bitewings - two radiographic images |
583 |
516 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
167 |
160 |
$14K |
| D2160 |
|
98 |
64 |
$9K |
| D1206 |
Topical application of fluoride varnish |
373 |
338 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
420 |
357 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
138 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
231 |
195 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
241 |
197 |
$3K |
| D2140 |
|
38 |
28 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$433.20 |