| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
608 |
579 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,030 |
970 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
373 |
353 |
$7K |
| D1120 |
Prophylaxis - child |
388 |
365 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
12 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
344 |
329 |
$4K |
| D0330 |
Panoramic radiographic image |
88 |
85 |
$4K |
| D0274 |
Bitewings - four radiographic images |
140 |
132 |
$2K |
| D1354 |
|
33 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
113 |
109 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
13 |
$405.70 |
| D2140 |
|
20 |
12 |
$61.90 |