| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,347 |
2,670 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,795 |
3,033 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,973 |
2,267 |
$45K |
| D1999 |
|
2,677 |
2,444 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,863 |
1,471 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,118 |
1,004 |
$26K |
| D0330 |
Panoramic radiographic image |
758 |
620 |
$23K |
| D1110 |
Prophylaxis - adult |
696 |
562 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
235 |
89 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
134 |
58 |
$5K |
| D1351 |
Sealant - per tooth |
304 |
76 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
63 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$214.40 |