| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,379 |
1,263 |
$28K |
| D1999 |
|
1,819 |
1,639 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,532 |
1,397 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
343 |
221 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
790 |
726 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
690 |
620 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
212 |
136 |
$10K |
| D0272 |
Bitewings - two radiographic images |
484 |
434 |
$7K |
| D2140 |
|
101 |
68 |
$4K |
| D1110 |
Prophylaxis - adult |
83 |
73 |
$2K |
| D1351 |
Sealant - per tooth |
51 |
12 |
$832.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
47 |
$488.92 |