| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,393 |
6,903 |
$139K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,380 |
8,789 |
$130K |
| D1999 |
|
9,488 |
8,784 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
7,594 |
7,144 |
$103K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,351 |
1,479 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,350 |
1,403 |
$79K |
| D1110 |
Prophylaxis - adult |
2,541 |
2,385 |
$64K |
| D0272 |
Bitewings - two radiographic images |
3,519 |
3,302 |
$50K |
| D2140 |
|
1,523 |
1,062 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,745 |
1,599 |
$34K |
| D0145 |
Oral evaluation for a patient under three years of age |
194 |
172 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
143 |
134 |
$906.01 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$60.00 |