| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
9,095 |
8,489 |
$130K |
| D1120 |
Prophylaxis - child |
5,645 |
5,415 |
$118K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,704 |
6,423 |
$97K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,890 |
1,113 |
$89K |
| D1351 |
Sealant - per tooth |
5,284 |
1,018 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,724 |
1,192 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
4,235 |
4,074 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,211 |
2,111 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,754 |
2,636 |
$43K |
| D1110 |
Prophylaxis - adult |
1,144 |
1,090 |
$37K |
| D0330 |
Panoramic radiographic image |
1,018 |
968 |
$35K |
| D2140 |
|
715 |
515 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
417 |
408 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
272 |
255 |
$6K |
| D2160 |
|
77 |
69 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
324 |
307 |
$3K |
| D2330 |
|
37 |
27 |
$2K |
| D2940 |
|
12 |
12 |
$235.63 |