| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,621 |
384 |
$37K |
| D1120 |
Prophylaxis - child |
1,714 |
1,505 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,134 |
1,884 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,366 |
1,186 |
$26K |
| D1999 |
|
1,632 |
1,432 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
432 |
270 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
311 |
171 |
$12K |
| D0272 |
Bitewings - two radiographic images |
815 |
737 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
307 |
171 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
697 |
631 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,465 |
1,019 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
942 |
797 |
$6K |
| D0330 |
Panoramic radiographic image |
143 |
140 |
$4K |
| D1110 |
Prophylaxis - adult |
151 |
150 |
$4K |
| D2140 |
|
126 |
86 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$228.58 |