| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,619 |
1,457 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
2,039 |
1,823 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
534 |
301 |
$14K |
| D0272 |
Bitewings - two radiographic images |
913 |
825 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
522 |
455 |
$7K |
| D1999 |
|
395 |
332 |
$6K |
| D1120 |
Prophylaxis - child |
247 |
213 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
575 |
466 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
83 |
42 |
$3K |
| D0330 |
Panoramic radiographic image |
34 |
33 |
$865.88 |
| D2140 |
|
34 |
27 |
$716.88 |
| D2330 |
|
17 |
12 |
$366.30 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
16 |
$152.92 |