| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
633 |
574 |
$26K |
| D0330 |
Panoramic radiographic image |
700 |
641 |
$24K |
| D1110 |
Prophylaxis - adult |
630 |
589 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,002 |
919 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
271 |
153 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
493 |
426 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
318 |
154 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
752 |
684 |
$10K |
| D0272 |
Bitewings - two radiographic images |
660 |
606 |
$10K |
| D2140 |
|
131 |
85 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
218 |
205 |
$4K |
| D0274 |
Bitewings - four radiographic images |
106 |
99 |
$2K |
| D2335 |
|
24 |
12 |
$2K |
| D9110 |
|
17 |
13 |
$321.80 |
| D0220 |
Intraoral - periapical first radiographic image |
47 |
43 |
$312.82 |