| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
494 |
446 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
850 |
732 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
899 |
784 |
$17K |
| D0272 |
Bitewings - two radiographic images |
559 |
493 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
52 |
$12K |
| D1120 |
Prophylaxis - child |
209 |
172 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
140 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
41 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
177 |
151 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$1K |
| D0601 |
|
190 |
185 |
$915.00 |
| D0602 |
|
15 |
15 |
$65.00 |