| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
606 |
597 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
785 |
772 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
208 |
78 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
78 |
50 |
$7K |
| D0330 |
Panoramic radiographic image |
117 |
115 |
$6K |
| D1120 |
Prophylaxis - child |
227 |
223 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
142 |
138 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
103 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
226 |
222 |
$4K |
| D0272 |
Bitewings - two radiographic images |
168 |
166 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
157 |
141 |
$2K |
| D2140 |
|
25 |
13 |
$2K |