| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
322 |
295 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
293 |
166 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
451 |
410 |
$6K |
| D1120 |
Prophylaxis - child |
355 |
327 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
245 |
136 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
295 |
272 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
418 |
383 |
$4K |
| D2140 |
|
185 |
110 |
$4K |
| D0272 |
Bitewings - two radiographic images |
243 |
222 |
$3K |
| D0330 |
Panoramic radiographic image |
36 |
33 |
$780.95 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$140.40 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$70.20 |