| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2140 |
|
489 |
266 |
$16K |
| D1110 |
Prophylaxis - adult |
601 |
525 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
338 |
$8K |
| D1999 |
|
343 |
342 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
72 |
40 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
133 |
115 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
108 |
68 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
338 |
141 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
25 |
$1K |
| D0272 |
Bitewings - two radiographic images |
71 |
49 |
$931.94 |
| D1120 |
Prophylaxis - child |
53 |
28 |
$847.80 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
41 |
$327.94 |