| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
25,980 |
21,274 |
$484K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,072 |
24,625 |
$420K |
| D1999 |
|
28,084 |
22,217 |
$417K |
| D0120 |
Periodic oral evaluation - established patient |
24,622 |
20,268 |
$340K |
| D1351 |
Sealant - per tooth |
15,374 |
2,632 |
$238K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,626 |
3,244 |
$234K |
| D0272 |
Bitewings - two radiographic images |
11,358 |
9,451 |
$163K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,449 |
1,924 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,127 |
3,274 |
$81K |
| D2140 |
|
2,238 |
1,201 |
$76K |
| D1110 |
Prophylaxis - adult |
2,624 |
2,120 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,731 |
2,384 |
$27K |
| D2160 |
|
492 |
381 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
353 |
221 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
603 |
477 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
208 |
185 |
$3K |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$1K |