| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,023 |
5,461 |
$168K |
| D1999 |
|
8,465 |
7,548 |
$121K |
| D0330 |
Panoramic radiographic image |
2,830 |
2,569 |
$86K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,874 |
1,285 |
$75K |
| D0272 |
Bitewings - two radiographic images |
4,867 |
4,396 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,271 |
2,868 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
3,992 |
3,696 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,584 |
2,279 |
$36K |
| D2140 |
|
816 |
582 |
$26K |
| D2160 |
|
417 |
329 |
$20K |
| D1120 |
Prophylaxis - child |
1,050 |
905 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
764 |
693 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,216 |
585 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,568 |
1,361 |
$11K |
| D1351 |
Sealant - per tooth |
378 |
56 |
$5K |
| D2331 |
|
15 |
12 |
$806.71 |
| D2330 |
|
18 |
14 |
$784.38 |