| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,958 |
1,942 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,350 |
2,332 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,796 |
1,741 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,200 |
1,192 |
$22K |
| D1120 |
Prophylaxis - child |
584 |
584 |
$15K |
| D1999 |
|
1,287 |
1,195 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
445 |
445 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
494 |
484 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
186 |
186 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
53 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
13 |
$895.31 |