| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,466 |
2,346 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
2,675 |
2,526 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,470 |
2,349 |
$60K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
814 |
570 |
$47K |
| D1351 |
Sealant - per tooth |
611 |
439 |
$39K |
| D1110 |
Prophylaxis - adult |
531 |
497 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,039 |
964 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
454 |
418 |
$9K |
| D0272 |
Bitewings - two radiographic images |
637 |
600 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,076 |
922 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
328 |
306 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
55 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
781 |
598 |
$4K |
| D2140 |
|
85 |
66 |
$3K |
| D2160 |
|
33 |
27 |
$2K |