| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
5,250 |
4,023 |
$77K |
| D1120 |
Prophylaxis - child |
2,433 |
1,933 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
872 |
420 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,686 |
2,129 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
739 |
436 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,745 |
1,350 |
$27K |
| D2140 |
|
587 |
388 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
918 |
741 |
$22K |
| D0272 |
Bitewings - two radiographic images |
476 |
344 |
$8K |
| D1351 |
Sealant - per tooth |
304 |
83 |
$5K |
| D1110 |
Prophylaxis - adult |
122 |
92 |
$4K |
| D0330 |
Panoramic radiographic image |
82 |
60 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
76 |
47 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
56 |
$717.13 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$696.64 |