| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,169 |
1,750 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,435 |
2,006 |
$43K |
| D1999 |
|
1,848 |
1,754 |
$32K |
| D0330 |
Panoramic radiographic image |
843 |
721 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,360 |
1,101 |
$17K |
| D1120 |
Prophylaxis - child |
721 |
581 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
731 |
560 |
$9K |
| D2140 |
|
331 |
170 |
$8K |
| D2330 |
|
339 |
91 |
$7K |
| D0272 |
Bitewings - two radiographic images |
618 |
438 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
170 |
82 |
$5K |
| D2940 |
|
35 |
30 |
$901.50 |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$763.17 |
| D0230 |
Intraoral - periapical each additional radiographic image |
420 |
144 |
$546.20 |
| D0220 |
Intraoral - periapical first radiographic image |
178 |
175 |
$488.24 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
47 |
12 |
$0.00 |