| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,670 |
1,382 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,459 |
2,022 |
$42K |
| D1120 |
Prophylaxis - child |
1,330 |
1,099 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
796 |
675 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
529 |
446 |
$22K |
| D0274 |
Bitewings - four radiographic images |
928 |
751 |
$21K |
| D0330 |
Panoramic radiographic image |
572 |
443 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,305 |
1,867 |
$16K |
| D1351 |
Sealant - per tooth |
912 |
163 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
300 |
224 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
585 |
463 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
438 |
391 |
$9K |
| D2140 |
|
241 |
167 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
615 |
507 |
$6K |
| D0272 |
Bitewings - two radiographic images |
482 |
399 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
25 |
$113.00 |
| D1999 |
|
191 |
119 |
$50.00 |