| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,516 |
2,346 |
$142K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,374 |
632 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
2,457 |
2,297 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
957 |
840 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
1,250 |
1,091 |
$46K |
| D0274 |
Bitewings - four radiographic images |
2,114 |
1,934 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,354 |
2,147 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,653 |
2,496 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
300 |
87 |
$32K |
| D2160 |
|
423 |
222 |
$28K |
| D1110 |
Prophylaxis - adult |
552 |
506 |
$20K |
| D1351 |
Sealant - per tooth |
1,568 |
143 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,493 |
1,083 |
$18K |
| D2161 |
|
107 |
51 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
52 |
$5K |
| D0272 |
Bitewings - two radiographic images |
483 |
434 |
$5K |
| D2140 |
|
21 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
16 |
12 |
$387.24 |
| D1208 |
Topical application of fluoride, excluding varnish |
124 |
100 |
$66.76 |