| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,220 |
560 |
$49K |
| D1120 |
Prophylaxis - child |
2,430 |
2,082 |
$46K |
| D1999 |
|
2,842 |
2,583 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,937 |
2,541 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
904 |
495 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,500 |
1,322 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
963 |
794 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
262 |
161 |
$12K |
| D0272 |
Bitewings - two radiographic images |
705 |
619 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
182 |
110 |
$8K |
| D1110 |
Prophylaxis - adult |
182 |
171 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
174 |
156 |
$1K |
| D2140 |
|
20 |
16 |
$788.40 |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
26 |
$513.59 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$445.32 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
12 |
$350.04 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
29 |
$275.92 |