| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,359 |
601 |
$38K |
| D1999 |
|
2,303 |
2,207 |
$32K |
| D1120 |
Prophylaxis - child |
1,340 |
1,303 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
517 |
205 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,637 |
1,594 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
479 |
459 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,270 |
1,247 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
671 |
319 |
$19K |
| D1110 |
Prophylaxis - adult |
314 |
307 |
$11K |
| D0272 |
Bitewings - two radiographic images |
696 |
681 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
169 |
159 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
511 |
493 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
58 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
64 |
60 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
128 |
122 |
$1K |