| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
5,316 |
4,892 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
5,186 |
4,774 |
$71K |
| D1999 |
|
4,634 |
4,386 |
$70K |
| D1120 |
Prophylaxis - child |
3,704 |
3,373 |
$70K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,502 |
788 |
$57K |
| D1110 |
Prophylaxis - adult |
1,807 |
1,660 |
$53K |
| D1351 |
Sealant - per tooth |
2,602 |
394 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,421 |
2,203 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
707 |
476 |
$23K |
| D2140 |
|
351 |
233 |
$11K |
| D0330 |
Panoramic radiographic image |
104 |
64 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
110 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
51 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
77 |
77 |
$430.40 |