| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2140 |
|
5,737 |
2,172 |
$328K |
| D0120 |
Periodic oral evaluation - established patient |
4,655 |
4,423 |
$106K |
| D1120 |
Prophylaxis - child |
3,580 |
3,404 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,275 |
4,070 |
$79K |
| D1351 |
Sealant - per tooth |
2,831 |
1,093 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,082 |
1,019 |
$56K |
| D1110 |
Prophylaxis - adult |
1,357 |
1,260 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,352 |
2,241 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
1,492 |
1,354 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
183 |
140 |
$13K |
| D9110 |
|
263 |
252 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
86 |
$7K |
| D1206 |
Topical application of fluoride varnish |
256 |
242 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
446 |
383 |
$4K |
| D0330 |
Panoramic radiographic image |
73 |
69 |
$3K |