| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,301 |
2,281 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
2,819 |
2,794 |
$70K |
| D1351 |
Sealant - per tooth |
2,385 |
503 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
650 |
443 |
$42K |
| D0330 |
Panoramic radiographic image |
909 |
900 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
436 |
306 |
$25K |
| D1120 |
Prophylaxis - child |
771 |
764 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,252 |
1,243 |
$23K |
| D2140 |
|
437 |
270 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
385 |
195 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,030 |
1,026 |
$17K |
| D0274 |
Bitewings - four radiographic images |
556 |
552 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
450 |
447 |
$13K |
| D2330 |
|
123 |
62 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
630 |
626 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
534 |
532 |
$5K |
| D2331 |
|
40 |
28 |
$2K |