| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
450 |
397 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
457 |
404 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
424 |
373 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
110 |
60 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
103 |
56 |
$6K |
| D0274 |
Bitewings - four radiographic images |
162 |
141 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
88 |
74 |
$2K |
| D0272 |
Bitewings - two radiographic images |
151 |
133 |
$1K |
| D2160 |
|
18 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
61 |
$1K |
| D1110 |
Prophylaxis - adult |
38 |
31 |
$965.20 |
| D0220 |
Intraoral - periapical first radiographic image |
169 |
145 |
$940.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
44 |
36 |
$277.40 |