| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
806 |
784 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
316 |
161 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
466 |
448 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
654 |
633 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
451 |
442 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
683 |
659 |
$9K |
| D0274 |
Bitewings - four radiographic images |
392 |
377 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
549 |
513 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
73 |
44 |
$4K |
| D1120 |
Prophylaxis - child |
124 |
115 |
$3K |
| D2140 |
|
28 |
17 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$947.55 |