| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
4,796 |
3,816 |
$71K |
| D1120 |
Prophylaxis - child |
2,911 |
2,321 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,449 |
2,762 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,797 |
2,194 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
685 |
373 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
563 |
317 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,584 |
1,270 |
$24K |
| D1110 |
Prophylaxis - adult |
310 |
247 |
$9K |
| D1351 |
Sealant - per tooth |
420 |
67 |
$7K |
| D0330 |
Panoramic radiographic image |
185 |
143 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
256 |
234 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
78 |
$822.40 |
| D2140 |
|
14 |
12 |
$550.38 |
| D0140 |
Limited oral evaluation - problem focused |
22 |
12 |
$459.58 |