| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,979 |
1,924 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,286 |
558 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,867 |
1,797 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
851 |
430 |
$49K |
| D1351 |
Sealant - per tooth |
1,111 |
390 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,470 |
1,434 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,239 |
1,184 |
$25K |
| D2140 |
|
397 |
213 |
$15K |
| D1110 |
Prophylaxis - adult |
419 |
394 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
925 |
867 |
$14K |
| D0274 |
Bitewings - four radiographic images |
845 |
810 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
535 |
501 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,161 |
2,057 |
$12K |
| D4341 |
|
58 |
31 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,391 |
1,330 |
$6K |
| D0272 |
Bitewings - two radiographic images |
388 |
381 |
$4K |
| D2160 |
|
55 |
39 |
$3K |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$612.85 |