| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
14,336 |
2,655 |
$220K |
| D0210 |
Intraoral - complete series of radiographic images |
2,517 |
2,235 |
$112K |
| D1120 |
Prophylaxis - child |
5,412 |
4,872 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,818 |
1,318 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,464 |
5,831 |
$92K |
| D1999 |
|
5,791 |
5,427 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
4,327 |
3,939 |
$60K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,070 |
436 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,390 |
2,169 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,679 |
1,476 |
$31K |
| D1110 |
Prophylaxis - adult |
947 |
896 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,342 |
1,197 |
$14K |
| D2140 |
|
85 |
52 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
136 |
124 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
429 |
339 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
105 |
103 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$182.00 |