| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,471 |
1,322 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,125 |
1,911 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,044 |
1,811 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,173 |
1,943 |
$42K |
| D1120 |
Prophylaxis - child |
699 |
615 |
$24K |
| D2140 |
|
142 |
83 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
13 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
131 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
62 |
39 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
128 |
109 |
$2K |
| D0602 |
|
322 |
219 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
15 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
26 |
$1K |
| D0603 |
|
255 |
195 |
$1K |
| D0601 |
|
145 |
114 |
$718.22 |