| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,485 |
2,381 |
$85K |
| D2140 |
|
1,260 |
743 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,081 |
2,766 |
$78K |
| D0330 |
Panoramic radiographic image |
1,374 |
1,146 |
$61K |
| D1110 |
Prophylaxis - adult |
1,625 |
1,243 |
$60K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
550 |
284 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,089 |
1,998 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,000 |
1,905 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,096 |
739 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
372 |
105 |
$10K |
| D1206 |
Topical application of fluoride varnish |
407 |
400 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
239 |
139 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
77 |
$990.00 |
| D0274 |
Bitewings - four radiographic images |
114 |
37 |
$918.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
14 |
$678.86 |