| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,703 |
2,657 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
3,987 |
3,924 |
$83K |
| D1206 |
Topical application of fluoride varnish |
4,969 |
4,887 |
$79K |
| D1120 |
Prophylaxis - child |
2,601 |
2,562 |
$77K |
| D0272 |
Bitewings - two radiographic images |
1,651 |
1,646 |
$29K |
| D0274 |
Bitewings - four radiographic images |
892 |
873 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
171 |
134 |
$15K |
| D0330 |
Panoramic radiographic image |
270 |
270 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
56 |
$5K |
| D1351 |
Sealant - per tooth |
102 |
31 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
71 |
$2K |
| D2140 |
|
36 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$829.91 |
| D1208 |
Topical application of fluoride, excluding varnish |
48 |
48 |
$695.87 |