| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
965 |
945 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
780 |
760 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
238 |
77 |
$11K |
| D0274 |
Bitewings - four radiographic images |
547 |
534 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
258 |
246 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
177 |
176 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
482 |
446 |
$2K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$888.30 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$166.50 |