| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,160 |
3,015 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
2,902 |
2,778 |
$79K |
| D1351 |
Sealant - per tooth |
960 |
659 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,749 |
1,669 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
281 |
217 |
$19K |
| D0274 |
Bitewings - four radiographic images |
913 |
872 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,864 |
1,776 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,667 |
1,590 |
$6K |
| D2140 |
|
144 |
123 |
$6K |
| D0272 |
Bitewings - two radiographic images |
600 |
574 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
157 |
154 |
$3K |
| D2160 |
|
22 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
28 |
$2K |