| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,244 |
7,097 |
$358K |
| D0120 |
Periodic oral evaluation - established patient |
8,805 |
8,613 |
$247K |
| D0330 |
Panoramic radiographic image |
4,273 |
4,142 |
$243K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,241 |
6,098 |
$127K |
| D0272 |
Bitewings - two radiographic images |
5,131 |
5,028 |
$112K |
| D1120 |
Prophylaxis - child |
2,750 |
2,673 |
$97K |
| D1351 |
Sealant - per tooth |
2,348 |
541 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
623 |
354 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,209 |
1,138 |
$56K |
| D2140 |
|
180 |
153 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
121 |
119 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$306.22 |