| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,073 |
6,035 |
$309K |
| D1206 |
Topical application of fluoride varnish |
9,671 |
9,612 |
$249K |
| D0120 |
Periodic oral evaluation - established patient |
8,376 |
8,327 |
$243K |
| D1110 |
Prophylaxis - adult |
2,652 |
2,638 |
$182K |
| D0272 |
Bitewings - two radiographic images |
2,102 |
2,078 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
193 |
190 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
74 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
25 |
$4K |
| D1351 |
Sealant - per tooth |
56 |
26 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
59 |
58 |
$1K |