| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,656 |
6,343 |
$273K |
| D1351 |
Sealant - per tooth |
2,340 |
1,474 |
$211K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,602 |
6,301 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
5,655 |
5,402 |
$159K |
| D0274 |
Bitewings - four radiographic images |
2,240 |
2,138 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,042 |
980 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,236 |
3,082 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,034 |
2,894 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
96 |
64 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
67 |
$1K |
| D0272 |
Bitewings - two radiographic images |
111 |
109 |
$1K |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$533.00 |
| D1999 |
|
39 |
36 |
$0.00 |
| D0190 |
|
39 |
36 |
$0.00 |