| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,461 |
1,918 |
$69K |
| D1999 |
|
2,884 |
2,224 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,106 |
1,618 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,645 |
1,315 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,261 |
972 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
919 |
738 |
$15K |
| D1120 |
Prophylaxis - child |
584 |
464 |
$11K |
| D1351 |
Sealant - per tooth |
641 |
51 |
$9K |
| D2140 |
|
249 |
112 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
109 |
64 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
146 |
122 |
$928.51 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$421.76 |
| D0140 |
Limited oral evaluation - problem focused |
30 |
25 |
$410.74 |
| D0230 |
Intraoral - periapical each additional radiographic image |
43 |
37 |
$172.00 |