| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,548 |
12,544 |
$526K |
| D0120 |
Periodic oral evaluation - established patient |
18,824 |
18,819 |
$464K |
| D2140 |
|
5,963 |
3,370 |
$314K |
| D1110 |
Prophylaxis - adult |
6,223 |
6,222 |
$279K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,222 |
17,166 |
$245K |
| D1351 |
Sealant - per tooth |
4,916 |
1,714 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,896 |
11,892 |
$163K |
| D0220 |
Intraoral - periapical first radiographic image |
17,202 |
17,196 |
$140K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,753 |
1,362 |
$120K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,166 |
1,166 |
$115K |
| D1206 |
Topical application of fluoride varnish |
1,148 |
1,148 |
$23K |
| D0601 |
|
2,815 |
2,815 |
$3K |
| D1999 |
|
44 |
44 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
38 |
$2K |
| D2330 |
|
17 |
12 |
$850.00 |
| D0602 |
|
824 |
824 |
$824.00 |
| D0603 |
|
661 |
661 |
$661.00 |
| D0274 |
Bitewings - four radiographic images |
20 |
20 |
$457.50 |