| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,307 |
4,935 |
$133K |
| D1110 |
Prophylaxis - adult |
2,539 |
2,392 |
$116K |
| D0272 |
Bitewings - two radiographic images |
4,225 |
3,951 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,777 |
4,465 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,422 |
655 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
4,274 |
3,561 |
$71K |
| D1120 |
Prophylaxis - child |
2,018 |
1,876 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
2,117 |
1,874 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,384 |
1,961 |
$31K |
| D2140 |
|
149 |
93 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
53 |
38 |
$4K |
| D1351 |
Sealant - per tooth |
154 |
35 |
$3K |