| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
704 |
680 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
625 |
611 |
$16K |
| D1351 |
Sealant - per tooth |
396 |
145 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
567 |
550 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
170 |
104 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
82 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
260 |
243 |
$5K |
| D0274 |
Bitewings - four radiographic images |
282 |
271 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
58 |
49 |
$4K |
| D1206 |
Topical application of fluoride varnish |
121 |
114 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
560 |
535 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
165 |
162 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
481 |
450 |
$2K |
| D1110 |
Prophylaxis - adult |
77 |
77 |
$2K |
| D2160 |
|
24 |
22 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
16 |
$1K |
| D0272 |
Bitewings - two radiographic images |
131 |
123 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
26 |
$63.67 |