| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,092 |
1,072 |
$26K |
| D1110 |
Prophylaxis - adult |
446 |
430 |
$18K |
| D1120 |
Prophylaxis - child |
341 |
333 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
586 |
570 |
$11K |
| D0272 |
Bitewings - two radiographic images |
435 |
434 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
130 |
84 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
59 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
13 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$2K |