| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,390 |
4,491 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,683 |
1,481 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,573 |
5,469 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
5,427 |
4,416 |
$73K |
| D1999 |
|
4,160 |
3,510 |
$66K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
943 |
477 |
$31K |
| D1110 |
Prophylaxis - adult |
1,009 |
820 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,400 |
1,190 |
$20K |
| D0330 |
Panoramic radiographic image |
637 |
585 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
954 |
916 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
328 |
299 |
$5K |
| D2140 |
|
112 |
67 |
$3K |
| D1351 |
Sealant - per tooth |
176 |
28 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
201 |
186 |
$1K |
| D2160 |
|
13 |
13 |
$449.67 |