| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
839 |
701 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
779 |
642 |
$7K |
| D0272 |
Bitewings - two radiographic images |
485 |
402 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
322 |
261 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
123 |
78 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
224 |
186 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
61 |
$2K |
| D1120 |
Prophylaxis - child |
129 |
112 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
250 |
195 |
$1K |
| D2160 |
|
15 |
14 |
$392.30 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$182.70 |
| D1999 |
|
91 |
84 |
$87.06 |