| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,793 |
1,705 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,845 |
1,761 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,032 |
962 |
$19K |
| D1351 |
Sealant - per tooth |
628 |
68 |
$18K |
| D0274 |
Bitewings - four radiographic images |
497 |
472 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
296 |
262 |
$9K |
| D1120 |
Prophylaxis - child |
169 |
164 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
55 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
55 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
108 |
76 |
$932.99 |
| D2140 |
|
16 |
12 |
$185.70 |