| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
2,359 |
2,227 |
$34K |
| D1120 |
Prophylaxis - child |
1,331 |
1,301 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,771 |
1,734 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,550 |
1,521 |
$24K |
| D1110 |
Prophylaxis - adult |
417 |
409 |
$14K |
| D1351 |
Sealant - per tooth |
794 |
161 |
$13K |
| D0272 |
Bitewings - two radiographic images |
644 |
635 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
195 |
133 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
12 |
$914.62 |
| D2140 |
|
21 |
14 |
$793.40 |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
79 |
$678.80 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
26 |
$645.28 |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
29 |
$286.36 |