| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,158 |
1,010 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,337 |
1,165 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
649 |
607 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
373 |
219 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
310 |
181 |
$8K |
| D1351 |
Sealant - per tooth |
498 |
115 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
553 |
453 |
$5K |
| D0272 |
Bitewings - two radiographic images |
391 |
353 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
508 |
433 |
$3K |
| D1110 |
Prophylaxis - adult |
123 |
107 |
$2K |
| D2140 |
|
108 |
74 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
679 |
397 |
$2K |