| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
1,725 |
1,562 |
$24K |
| D1120 |
Prophylaxis - child |
1,216 |
1,157 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,653 |
1,501 |
$20K |
| D1999 |
|
961 |
745 |
$14K |
| D0272 |
Bitewings - two radiographic images |
944 |
921 |
$13K |
| D1110 |
Prophylaxis - adult |
490 |
489 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
313 |
213 |
$8K |
| D1351 |
Sealant - per tooth |
450 |
90 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
269 |
182 |
$6K |
| D2140 |
|
220 |
155 |
$5K |
| D0330 |
Panoramic radiographic image |
170 |
168 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
312 |
310 |
$4K |
| D2160 |
|
48 |
42 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
132 |
132 |
$677.32 |
| D2940 |
|
38 |
27 |
$663.50 |
| D0140 |
Limited oral evaluation - problem focused |
50 |
49 |
$645.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$68.00 |