| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,575 |
993 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,425 |
627 |
$98K |
| D1999 |
|
6,025 |
4,209 |
$85K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,560 |
665 |
$74K |
| D1120 |
Prophylaxis - child |
3,037 |
2,206 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,411 |
2,473 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,846 |
1,444 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,928 |
1,289 |
$30K |
| D0330 |
Panoramic radiographic image |
870 |
596 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,325 |
955 |
$20K |
| D2140 |
|
208 |
111 |
$8K |
| D1110 |
Prophylaxis - adult |
191 |
128 |
$6K |
| D2160 |
|
63 |
37 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
36 |
29 |
$2K |