| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,958 |
1,951 |
$99K |
| D1120 |
Prophylaxis - child |
2,104 |
2,096 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,102 |
2,094 |
$23K |
| D0274 |
Bitewings - four radiographic images |
901 |
896 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,011 |
2,011 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
169 |
94 |
$11K |
| D0272 |
Bitewings - two radiographic images |
549 |
549 |
$6K |
| D1351 |
Sealant - per tooth |
114 |
25 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
13 |
$1K |