| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
563 |
485 |
$12K |
| D2140 |
|
468 |
245 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
382 |
324 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
436 |
361 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
267 |
221 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
42 |
$1K |
| D1120 |
Prophylaxis - child |
78 |
64 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
152 |
112 |
$677.36 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
16 |
$477.30 |