| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
328 |
312 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
397 |
378 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
221 |
210 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
192 |
180 |
$5K |
| D9110 |
|
87 |
82 |
$5K |
| D1110 |
Prophylaxis - adult |
174 |
164 |
$4K |
| D1351 |
Sealant - per tooth |
87 |
25 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
161 |
152 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
453 |
386 |
$3K |
| D0274 |
Bitewings - four radiographic images |
171 |
163 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
421 |
400 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
39 |
26 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$746.20 |