| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
548 |
189 |
$28K |
| D1120 |
Prophylaxis - child |
340 |
293 |
$13K |
| D1351 |
Sealant - per tooth |
241 |
89 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
389 |
336 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
338 |
290 |
$8K |
| D0274 |
Bitewings - four radiographic images |
246 |
221 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
244 |
217 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
204 |
186 |
$4K |
| D1110 |
Prophylaxis - adult |
143 |
126 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
548 |
486 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
265 |
235 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
138 |
125 |
$1K |