| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
8,703 |
7,051 |
$130K |
| D1120 |
Prophylaxis - child |
6,723 |
5,452 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,034 |
7,305 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
6,619 |
5,390 |
$94K |
| D0272 |
Bitewings - two radiographic images |
3,774 |
3,091 |
$55K |
| D1351 |
Sealant - per tooth |
2,881 |
462 |
$42K |
| D1110 |
Prophylaxis - adult |
1,304 |
1,046 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
805 |
474 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
800 |
456 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,312 |
1,035 |
$27K |
| D0330 |
Panoramic radiographic image |
193 |
119 |
$7K |
| D2140 |
|
215 |
148 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
81 |
63 |
$626.18 |