| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,105 |
2,104 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
1,844 |
1,844 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
945 |
940 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,629 |
1,626 |
$17K |
| D0274 |
Bitewings - four radiographic images |
991 |
991 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,050 |
2,044 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
826 |
825 |
$15K |
| D1120 |
Prophylaxis - child |
158 |
158 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
492 |
492 |
$5K |
| D0272 |
Bitewings - two radiographic images |
211 |
211 |
$3K |
| D1351 |
Sealant - per tooth |
51 |
14 |
$2K |
| D2160 |
|
29 |
15 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
148 |
147 |
$232.54 |
| D1999 |
|
214 |
213 |
$0.00 |