| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,530 |
1,506 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,427 |
2,387 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
383 |
245 |
$22K |
| D1206 |
Topical application of fluoride varnish |
779 |
763 |
$12K |
| D2140 |
|
210 |
134 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
92 |
56 |
$5K |
| D2330 |
|
100 |
54 |
$4K |
| D1120 |
Prophylaxis - child |
146 |
144 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
133 |
131 |
$3K |
| D0272 |
Bitewings - two radiographic images |
200 |
192 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
93 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
184 |
171 |
$2K |