| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
1,775 |
1,369 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
854 |
431 |
$23K |
| D1120 |
Prophylaxis - child |
1,353 |
1,020 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,629 |
1,256 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
699 |
394 |
$18K |
| D0330 |
Panoramic radiographic image |
720 |
513 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,317 |
1,112 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
901 |
591 |
$13K |
| D1110 |
Prophylaxis - adult |
388 |
324 |
$9K |
| D2140 |
|
370 |
207 |
$8K |
| D2940 |
|
379 |
200 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
914 |
644 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
146 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
234 |
153 |
$1K |