| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,614 |
3,216 |
$95K |
| D1999 |
|
3,094 |
2,821 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
3,112 |
2,721 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,677 |
2,427 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,583 |
1,440 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,259 |
2,838 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,622 |
1,420 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,925 |
2,657 |
$21K |
| D1120 |
Prophylaxis - child |
832 |
736 |
$15K |
| D1351 |
Sealant - per tooth |
665 |
66 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
248 |
129 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
205 |
191 |
$3K |
| D2140 |
|
54 |
28 |
$1K |
| D2160 |
|
16 |
14 |
$498.00 |
| D9995 |
|
16 |
16 |
$210.00 |