| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
1,758 |
1,634 |
$27K |
| D1120 |
Prophylaxis - child |
1,126 |
1,070 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,191 |
1,131 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
541 |
498 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
248 |
155 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
616 |
603 |
$9K |
| D0272 |
Bitewings - two radiographic images |
213 |
203 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
46 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
62 |
59 |
$2K |
| D2140 |
|
17 |
13 |
$674.39 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$112.16 |