| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,174 |
3,502 |
$115K |
| D1999 |
|
5,325 |
4,283 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
3,533 |
3,065 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,599 |
2,135 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,636 |
1,259 |
$38K |
| D0330 |
Panoramic radiographic image |
910 |
709 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,688 |
1,456 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,734 |
1,060 |
$20K |
| D1120 |
Prophylaxis - child |
1,093 |
945 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,305 |
1,167 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
186 |
137 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
111 |
$2K |
| D2160 |
|
15 |
12 |
$855.07 |
| D2140 |
|
19 |
13 |
$753.73 |