| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,306 |
1,240 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,434 |
1,368 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
394 |
219 |
$25K |
| D0330 |
Panoramic radiographic image |
307 |
300 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
512 |
487 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
477 |
451 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
51 |
39 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
124 |
116 |
$2K |
| D2140 |
|
45 |
26 |
$1K |
| D1120 |
Prophylaxis - child |
44 |
43 |
$1K |
| D0274 |
Bitewings - four radiographic images |
60 |
58 |
$1K |
| D0272 |
Bitewings - two radiographic images |
69 |
63 |
$544.00 |