| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
334 |
332 |
$14K |
| D1120 |
Prophylaxis - child |
316 |
314 |
$9K |
| D1206 |
Topical application of fluoride varnish |
302 |
300 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
139 |
131 |
$5K |
| D0274 |
Bitewings - four radiographic images |
182 |
180 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
31 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
36 |
36 |
$1K |
| D0272 |
Bitewings - two radiographic images |
74 |
74 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
91 |
84 |
$1K |