| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
4,191 |
3,811 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,359 |
3,918 |
$60K |
| D1120 |
Prophylaxis - child |
2,914 |
2,605 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
3,290 |
2,999 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
959 |
595 |
$43K |
| D1110 |
Prophylaxis - adult |
1,482 |
1,351 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,202 |
1,052 |
$24K |
| D0330 |
Panoramic radiographic image |
775 |
701 |
$23K |
| D0272 |
Bitewings - two radiographic images |
782 |
702 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
264 |
157 |
$10K |
| D1351 |
Sealant - per tooth |
480 |
107 |
$7K |
| D2140 |
|
130 |
85 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
54 |
36 |
$315.68 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$103.08 |