| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,726 |
3,698 |
$154K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,193 |
6,141 |
$114K |
| D1120 |
Prophylaxis - child |
2,632 |
2,606 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
3,820 |
3,807 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
883 |
403 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,242 |
2,218 |
$54K |
| D2140 |
|
947 |
728 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
685 |
521 |
$46K |
| D0330 |
Panoramic radiographic image |
767 |
758 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,036 |
1,022 |
$32K |
| D1351 |
Sealant - per tooth |
851 |
243 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
735 |
712 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
359 |
345 |
$15K |
| D0272 |
Bitewings - two radiographic images |
480 |
480 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
164 |
155 |
$2K |