| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
19,570 |
17,981 |
$270K |
| D1120 |
Prophylaxis - child |
14,290 |
13,132 |
$259K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,678 |
3,070 |
$238K |
| D0120 |
Periodic oral evaluation - established patient |
16,739 |
15,395 |
$220K |
| D1999 |
|
13,758 |
13,054 |
$199K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,750 |
2,057 |
$172K |
| D1110 |
Prophylaxis - adult |
5,996 |
5,516 |
$156K |
| D0272 |
Bitewings - two radiographic images |
10,099 |
9,259 |
$143K |
| D0330 |
Panoramic radiographic image |
3,604 |
3,298 |
$102K |
| D2140 |
|
2,640 |
1,318 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,170 |
2,935 |
$64K |
| D2160 |
|
757 |
445 |
$33K |
| D1351 |
Sealant - per tooth |
1,095 |
152 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
135 |
93 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
257 |
219 |
$2K |
| D2940 |
|
17 |
12 |
$456.91 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$142.89 |