| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
6,532 |
5,967 |
$89K |
| D1120 |
Prophylaxis - child |
4,606 |
4,204 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
6,039 |
5,528 |
$79K |
| D1999 |
|
4,786 |
4,389 |
$75K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,132 |
1,195 |
$75K |
| D1351 |
Sealant - per tooth |
4,525 |
966 |
$64K |
| D1110 |
Prophylaxis - adult |
2,176 |
2,006 |
$56K |
| D0272 |
Bitewings - two radiographic images |
3,620 |
3,322 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,255 |
729 |
$39K |
| D0330 |
Panoramic radiographic image |
695 |
623 |
$19K |
| D2140 |
|
600 |
411 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
517 |
478 |
$8K |
| D2160 |
|
121 |
95 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
512 |
480 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
712 |
493 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$152.10 |