| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,583 |
1,508 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,757 |
1,670 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,460 |
1,383 |
$37K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
453 |
369 |
$32K |
| D2140 |
|
408 |
345 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
250 |
197 |
$13K |
| D1110 |
Prophylaxis - adult |
355 |
324 |
$13K |
| D0274 |
Bitewings - four radiographic images |
800 |
754 |
$13K |
| D1351 |
Sealant - per tooth |
183 |
127 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
421 |
390 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
962 |
895 |
$5K |
| D0272 |
Bitewings - two radiographic images |
483 |
456 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
241 |
226 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
581 |
522 |
$3K |
| D1206 |
Topical application of fluoride varnish |
108 |
108 |
$3K |
| D2160 |
|
12 |
12 |
$822.60 |
| D1999 |
|
568 |
411 |
$0.00 |