| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,563 |
1,456 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,472 |
1,365 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,308 |
1,217 |
$35K |
| D0274 |
Bitewings - four radiographic images |
759 |
687 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,646 |
1,538 |
$9K |
| D1351 |
Sealant - per tooth |
193 |
68 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
49 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,639 |
1,450 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
188 |
182 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
54 |
34 |
$4K |
| D0272 |
Bitewings - two radiographic images |
250 |
242 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
13 |
$1K |
| D1110 |
Prophylaxis - adult |
29 |
29 |
$1K |
| D1206 |
Topical application of fluoride varnish |
37 |
34 |
$950.85 |
| D2140 |
|
20 |
13 |
$925.50 |
| D0140 |
Limited oral evaluation - problem focused |
45 |
45 |
$712.80 |
| D0330 |
Panoramic radiographic image |
16 |
14 |
$316.40 |