| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,931 |
2,928 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,709 |
3,703 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,590 |
2,588 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
673 |
547 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
375 |
375 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,836 |
1,834 |
$8K |
| D1120 |
Prophylaxis - child |
267 |
267 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
890 |
882 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
556 |
550 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
97 |
89 |
$5K |
| D2140 |
|
17 |
15 |
$673.28 |
| D1208 |
Topical application of fluoride, excluding varnish |
40 |
40 |
$408.09 |