| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2140 |
|
5,699 |
1,946 |
$317K |
| D0120 |
Periodic oral evaluation - established patient |
4,075 |
3,888 |
$96K |
| D1120 |
Prophylaxis - child |
2,590 |
2,488 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,675 |
3,518 |
$68K |
| D1110 |
Prophylaxis - adult |
1,546 |
1,469 |
$60K |
| D1351 |
Sealant - per tooth |
2,368 |
875 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,315 |
2,221 |
$39K |
| D9110 |
|
603 |
552 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,078 |
1,857 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
160 |
115 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
940 |
728 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
144 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
25 |
$4K |
| D1206 |
Topical application of fluoride varnish |
112 |
109 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$861.77 |