| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
617 |
488 |
$14K |
| D0272 |
Bitewings - two radiographic images |
621 |
490 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
340 |
184 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
343 |
258 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
213 |
137 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
323 |
257 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
437 |
348 |
$4K |
| D2140 |
|
140 |
83 |
$3K |
| D1120 |
Prophylaxis - child |
180 |
136 |
$3K |
| D1999 |
|
109 |
108 |
$3K |
| D2160 |
|
28 |
24 |
$849.80 |
| D0220 |
Intraoral - periapical first radiographic image |
110 |
90 |
$544.40 |