| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
11,777 |
10,932 |
$177K |
| D1120 |
Prophylaxis - child |
6,678 |
6,536 |
$134K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,600 |
7,425 |
$111K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,248 |
1,482 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
6,018 |
5,902 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,703 |
1,286 |
$88K |
| D0272 |
Bitewings - two radiographic images |
2,547 |
2,489 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,512 |
1,467 |
$36K |
| D2140 |
|
789 |
559 |
$31K |
| D1110 |
Prophylaxis - adult |
878 |
854 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,756 |
777 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,455 |
1,410 |
$12K |
| D1351 |
Sealant - per tooth |
510 |
100 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
409 |
388 |
$8K |
| D2160 |
|
78 |
66 |
$5K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$748.13 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$293.51 |