| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,004 |
11,234 |
$497K |
| D1351 |
Sealant - per tooth |
15,205 |
3,066 |
$313K |
| D0120 |
Periodic oral evaluation - established patient |
7,922 |
7,537 |
$184K |
| D0272 |
Bitewings - two radiographic images |
10,484 |
9,792 |
$173K |
| D2140 |
|
3,039 |
1,575 |
$131K |
| D0240 |
|
6,765 |
4,627 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,935 |
11,160 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
2,538 |
2,147 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,584 |
5,250 |
$69K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,314 |
650 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,112 |
6,983 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,743 |
1,643 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
793 |
470 |
$30K |
| D1353 |
|
1,373 |
260 |
$16K |
| D0999 |
Unspecified diagnostic procedure, by report |
277 |
277 |
$8K |
| D1999 |
|
103 |
103 |
$2K |
| D9987 |
|
27 |
27 |
$0.00 |
| D9986 |
|
150 |
144 |
$0.00 |